Breast Cancer: The Accuracy of The Paus in Detecting pN2 and Factors that Lead to the True- and False-Negative Results

Artmonienė, Dalia; Boguševičius, Algirdas; Jonaitienė, Eglė; Paukštaitienė, Renata; Veikutis, Vincentas; Basevičiūtė, Milda; Stasiukynaitė, Karolina; Dong, Fenglin; Wang, Jiannan

doi:10.26717/bjstr.2019.12.002301

Cited by 2 publications

(8 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some previous studies have reported associations between higher tumor grade (G3) and an increased likelihood of false-negative PAUS results [2,11]. However, we did not find any difference in the false-negative rate depending on tumor grade.…”

Section: Discussioncontrasting

confidence: 90%

“…The false-negative rate in the pT2-pT4 group was 8.2%, and in the pT1 group, it was 1.7%, being very similar to the rate in our study [10]. Several studies have demonstrated that larger tumor sizes were more often associated with false-negative results of ultrasound [2,11,[41][42][43]. These results show that smaller tumors are generally associated with a lower likelihood of nodal positivity, so a lower false-negative rate could be expected with lower pathologic T size.…”

Section: Discussionsupporting

confidence: 88%

“…Some studies examined ultrasound ability to discriminate between minimal and heavy axillary metastatic burden. In all these studies, the NPV and the accuracy of the PAUS increased to 86-98.4% and 81.2-98.5% in cases with a heavy nodal burden [10,11,16,35]. In the current study, the NPV and the accuracy of PAUS in detecting a heavy nodal burden increased to 98.3% and to 88.7%, respectively.…”

Section: Discussionsupporting

confidence: 55%

“…In our study, the accuracy of the ultrasound examination was also quite high (84.1%). In other studies, it varied from 66% to 90.2% [2,8,10,11,35,39].…”

Section: Discussionmentioning

confidence: 98%

“…Considering that both SLNB and lymphadenectomy (axillary lymph node dissection, ALND) are not treatment procedures, but are performed with the aim of tumor staging, recently much attention has been given to the identification of non-invasive procedures for diagnostic purposes [8]. Preoperative axillary ultrasound (PAUS) is a first-line method to evaluate axillary nodal status [9][10][11]. Currently, there are two ongoing clinical studies (SOUND and INSEMA) that aim at evaluating differences in overall survival, disease-free survival, and quality of life in women with breast cancer by dividing them into two groups: women who underwent SLNB and women who had clinically and sonographically tumor-free axillary lymph nodes (c/sN0) and did not undergo SLNB [12,13].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Rukanskienė¹,

Veikutis²,

Jonaitienė³

et al. 2020

Medicina

View full text Add to dashboard Cite

Background and objectives: With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50–75% to 15–30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients’ and tumor characteristics leading to false-negative results. Materials and Methods: A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. Results: Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, p < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), p = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, p < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, p < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients’ group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution.

show abstract

Section: Discussioncontrasting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 55%

“…In our study, the accuracy of the ultrasound examination was also quite high (84.1%). In other studies, it varied from 66% to 90.2% [2,8,10,11,35,39].…”

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Rukanskienė¹,

Veikutis²,

Jonaitienė³

et al. 2020

Medicina

View full text Add to dashboard Cite

show abstract

Ultrasound Morphology of Axillary Lymph Nodes as a Non-invasive Alternative to Detect Metastasis in Early Breast Cancer

Manohar,

Aroult

2024

Annals of SBV

View full text Add to dashboard Cite

The axillary lymph node status is the most important prognostic factor in early stage breast cancer. A sentinel lymph node biopsy determines whether axillary node dissection is necessary. The use of the operating room and the administration of radioisotopes are also costs associated with this operation. As a result, patients with nodal metastases that could lead to axillary dissection should be identified before surgery. Axillary ultrasound is widely being used to determine nodal status prior to surgery. It has been shown to be a receptive and accurate modality for detecting nodal metastases. When combined with fine-needle aspiration, this modality's precision is greatly improved. This article discusses preoperative axillary ultrasound (PAUS) in early and locally advanced breast cancer patients with and without fine-needle aspiration biopsy. Based on this analysis, we estimate the proportion of patients who would be able to escape a sentinel lymph node biopsy, as well as the cost benefit of axillary ultrasound.

show abstract

Breast Cancer: The Accuracy of The Paus in Detecting pN2 and Factors that Lead to the True- and False-Negative Results

Cited by 2 publications

References 18 publications

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Ultrasound Morphology of Axillary Lymph Nodes as a Non-invasive Alternative to Detect Metastasis in Early Breast Cancer

Contact Info

Product

Resources

About