Comparison between Ultrasound and Pathologic Status of Axillary Lymph Nodes in Clinically Node-negative Breast Cancer Patients

Abstract

Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in clinically node-negative breast cancer patients. Ultrasound (US) has shown promise when used to assess axillary lymph nodes preoperatively, thus aiding surgical decision making. We examined the correlation between preoperative US and SLNB results to further clarify the role of US in clinicopathologic staging of breast cancer when the axilla is clinically negative on physical examination. Our institutional cancer registry was used to identify clinically node-negative patients diagnosed with breast cancer from January 1, 2009 to December 31, 2012. Variables including age, body mass index, date of surgery, date of diagnosis, US results, US-directed biopsy results, SLNB results, and final pathology were recorded. Incomplete charts were excluded. In all, 249 patients were included. Sensitivity/specificity of US in the clinically negative axilla were 7.4 per cent and 91.8 per cent, respectively. The false-positive rate was 80 per cent, whereas the negative predictive value was 78 per cent. The effect of time from diagnosis/US to SLNB, interpreting radiologist, year in which US was performed, and body mass index were not statistically significant. US in the clinically node-negative patient, although useful when it leads to a positive needle biopsy result, is unlikely to replace SLNB owing to its low sensitivity and a high false-positive rate. Further prospective study into the role of US in the evaluation of the clinically negative axilla is warranted.

Role of Contrast‐Enhanced Sonography in the Evaluation of Axillary Lymph Nodes in Breast Carcinoma: A Monocentric Study

“…Some studies showed that these techniques, especially if combined, had good levels of sensitivity, specificity, and accuracy, although not comparable to biopsy. Some other works, even recently, reported different results overall for the sensitivity. We tried to evaluate the impact of the use of contrast‐enhanced sonography in this general context.…”

Deep Learning vs. Radiomics for Predicting Axillary Lymph Node Metastasis of Breast Cancer Using Ultrasound Images: Don't Forget the Peritumoral Region

“…As palpation is inaccurate (29), AUS is performed to provide more relevant information. AUS alone has a reported sensitivity of 39-60%, specificity of 90-96%, PPV of 80-91%, and NPV of 75-83% (6,30,31). This implied that despite of an acceptable specificity above 90%, prior to surgery about 40-60% of nodal metastases cannot be found by AUS and about 20-25% of patients with a negative AUS have been assessed as modal metastases after surgery.…”

Determining Whether High Nodal Burden in Early Breast Cancer Patients Can Be Predicted Preoperatively to Avoid Sentinel Lymph Node Biopsy

“…While SLNB remains the gold standard for the assessment of axillary nodal burden [3], it may be an unnecessary procedure in the HNB group who require an ALND if we can identify this subgroup preoperatively [4]. However, only a limited amount of data is available to distinguish the HNB group preoperatively.…”