Correlation of Conventional Ultrasound Characteristics of Breast Tumors With Axillary Lymph Node Metastasis and Ki‐67 Expression in Patients With Breast Cancer

Abstract

Objectives-To explore the association between the ultrasound (US) characteristics of breast tumors with axillary lymph node metastasis (ALNM) and Ki-67 expression in patients with breast cancer.Methods-In total, 527 consecutive patients with breast cancer who had undergone US examinations and curative surgery with axillary lymph node evaluations were included. The size, shape, aspect ratio, margin, internal echo, internal calcification, posterior echo attenuation, lymphatic hilar structure, cortical thickness, and blood flow of the axillary lymph nodes or primary breast lesions were observed with conventional US. Pathologic prognostic factors, including the histologic type of the tumor, histologic grade, estrogen and progesterone receptor status, lymph node status, and Ki-67 expression were determined. A logistic regression model was used to evaluate whether the US characteristics of primary breast lesions were associated with ALNM and Ki-67 expression.Results-The maximum tumor diameter (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.05-2.27; P = .028), tumor margin (OR, 2.89; 95% CI, 1.69-4.94; P < .001), internal echo (OR, 2.17; 95% CI, 1.47-3.20; P < .001), and Ki-67 status (OR, 3.57; 95% CI, 2.29-5.58; P < .001) had significant value as independent predictors of ALNM. Only the internal echo (OR, 1.95; 95% CI, 1.28-2.95; P = .002) of breast cancer was an independent predictor of the Ki-67 status. The heterogeneity in the internal echo indicated faster cancer cell proliferation and was associated with a worse prognosis in patients with breast carcinoma.Conclusions-Certain conventional US characteristics may be useful predictors of ALNM and the Ki-67 status in patients with breast cancer.

Reply

“…To the Editor : We are very grateful to you for your invitation and for Dr Altundag's comments. We feel very honored to know that “Correlation of Conventional Ultrasound Characteristics of Breast Tumors With Axillary Lymph Node Metastasis and Ki‐67 Expression in Patients With Breast Cancer” has been published online in Early View of the Journal of Ultrasound in Medicine . Here, we will elaborate Dr Altundag's question from 2 aspects as follows.…”

“…First, it was a pity that we did not take triple‐negative breast cancer into consideration; however, triple‐negative breast cancer was not the focus of our study. The sentence “Triple‐negative breast cancer patients with high expression of Ki‐67 were expected to have more tendency for ALNM,“ instead of being the conclusion of the study, was actually our own point of view. The Ki‐67 protein, a nonhistone nuclear protein, is exclusively related to cell proliferation.…”

Relationship Between Ultrasound Features and Ki-67 Labeling Index of Soft Tissue Sarcoma

“…In intraoperative ultrasonography (IOUS), Baskan et al (23) found that the pathogenicity of the solid parts, margins, and contours of glioma were related to the level of Ki-67. Zhang et al (24) discovered that breast cancer with heterogeneous internal echo had stronger proliferative ability and poor prognosis. Compared with other studies, in addition to the differences in tumor types, the constituent cells of different subtypes of STS are diverse.…”

Staging of the Axilla in Breast Cancer and the Evolving Role of Axillary Ultrasound

“…A cortical thickness of greater than 3 mm is associated with more than three-fold increase in metastatic disease, loss of fatty hilum is associated with a 27-fold increase, and tumor margin irregularity is associated with a 3-fold increase. 38 , 39 Lymph node diameter greater than 10 mm is also associated with increased risk of metastatic disease. While these features have high odds ratios, individually they have poor AUC in predicting the presence of metastatic disease.…”