Clinicopathological Factors Associated With Positive Preoperative Axillary Ultrasound Scanning in Breast Cancer Patients

Abstract

Background: Axillary lymph node status is the most important breast cancer prognostic factor. Preoperative axillary ultrasound examination (PAUS) is used to triage patients for sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). We assessed the detection rate of lymph node metastases by PAUS in a screening unit and evaluated associations between clinicopathological factors and PAUS positivity. Patients and Methods: This was a single-centre retrospective analysis of data extracted from a hospital breast cancer database and clinical records. Clinical, radiological, and pathological and prognostic indices were compared between PAUS-positive and PAUS-negative patients subsequently found to have lymph node metastases on histopathological analysis. Results: Two hundred and two patients were eligible for analysis. 50.5% of lymph node-positive patients were correctly identified as PAUS positive. Patients with PAUS-positive lymph nodes had less favourable disease characteristics, namely clinically palpable lymph nodes, higher Nottingham prognostic index (NPI), high lymph node burden according to the European Society of Medical Oncology (ESMO) group classification, and larger, grade 3 tumours with lymphovascular invasion and extranodal spread. Moreover, PAUS-positive patients had more macrometastases and lymph node involvement than PAUS-negative patients. Conclusion: PAUS-positive patients and PAUS-negative (SLNB-positive) patients have different clinicopathological characteristics. The presence of LVI, extranodal spread, grade 3 histology, or large tumours with poor prognostic indexes in PAUS-negative patients should be regarded with caution and perhaps prompt second-look ultrasound examination.

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

“…Few studies have been conducted to analyze the causes of false-negative results of an ultrasound examination. Jalin's study suggests that the negative results of PAUS study should be evaluated with caution when the tumor is larger (≥ T2), poorly differentiated (G3), or when tumor spreading in blood vessels and lymphatic vessels is detected, as that increases the probability of false-negative results [3]. Nwaugu's study also suggests that the probability of false-negative outcomes increases when the tumor is larger and the tumor spreading in blood vessels and lymph nodes is diagnosed, but the tumor differentiation degree is not statistically significant [15].…”

“…On the contrary, in the younger age group with a larger (T2), poorly-differentiated (G3) tumor, and the Volume 12-Issue 5: 2019 9470 detection of tumor spreading in Blood Vessels (V1) and Lymphatic Vessels (L1), the probability of false-negative results is increased; therefore, in these cases, the results of the PAUS study should be evaluated more cautiously. Several studies identified that a heavy nodal disease burden (pN2) and worse prognostic factors of disease (T2, G3, VL1) were detected more frequently in the PAUS-positive group [1,[3][4][5]7,22,24]. Also in our study, in the PAUS-positive group after surgery, a heavy nodal disease burden (pN2) and worse prognostic factors of disease (T2 (p<0.0001), G3 (p=0.034), LV1 (p<0.0001)) were detected more frequently.…”

“…The condition of Axillary Lymph Nodes (ALN) is the most important prognostic factor in breast cancer and is relevant to the choice of breast cancer treatment tactics [1,2]. There is a strong correlation between the number of damaged axillary lymph nodes and the risk of breast cancer regeneration [3]. Since 1994, Sentinel Lymph Node Biopsy (SLNB) has become a gold standard for assessing the status of the axillary lymph nodes.…”