Diagnostic accuracy of axillary staging by ultrasound in early breast cancer patients

Riedel, Fabian; Schaefgen, Benedikt; Sinn, Hans‐Peter; Feißt, Manuel; Hennigs, André; Hug, Sarah; Binnig, Angela; Gomez, Christina; Harcos, Aba; Stieber, Anne; Kauczor, Hans‐Ulrich; Sohn, Christof; Golatta, Michael; Glaeser, Antonia; Heil, Joerg

doi:10.1016/j.ejrad.2020.109468

Cited by 27 publications

(30 citation statements)

References 29 publications

(38 reference statements)

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“…The overall study population diagnostic accuracy of US was in concordance with recently published papers on a large cohort of patients of average risk [2,14,15]. We obtained an overall sensitivity of 75% with a PPV of 85%, but a slightly lower sensitivity of 66% due to the pathogenic mutation carrier patients.…”

Section: Discussionsupporting

confidence: 89%

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients

Pintican

Duma²,

Szep

et al. 2021

JPM

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Purpose: The aim of this study is to evaluate the role of US in depicting axillary nodal disease in high-risk patients with and without pathogenic mutations. Methods: The retrospective study included consecutive high-risk breast cancer (BC) patients who underwent a multigene testing panel for hereditary cancers, pre-operative axillary US and breast/axillary surgery. The group was divided into patients with pathogenic mutations (PM group) and patients without PM. Statistical analyses were performed using GraphPad Prism by applying Chi-square and Fisher exact tests, with a reference p-value < 0.05 and a CI of 95%. Results: Out of 190 patients with BC, 96 (51%) were negative and 94 (49%) were positive for PM as follows: 28 (25.5%) BRCA1, 16 (17%) BRCA2, 15 (16%) CHECK2, 14 (14%) RAD Group, 7 (7%) PALB, 6 (6%) NBN, 3 (3%) TP53 and ATM and 2 (2%) BARD1. US was positive in 88 of the patients, 36 with PM and 52 without PM. US and surgery (>= N1 stage) were both positive in 31 (62%) of PM patients and 44 (88%) of patients without genetic changes. There were 19 (61%) false negative US examinations in the PM group and 6 (13%) in the group without genetic changes, respectively. If the US is positive, there is a 2.6 times greater risk of positive nodes in PM patients (p-value < 0.000, 95% CI = 4.2–37.9), and a 6.2 times greater risk of positive nodes in patients without genetic changes (p-value < 0.000, 95%CI = 8.4–37.4). In the PM group, US compared to surgery reached a sensitivity = 62, with PPV = 86 and NPV = 67. In the BRCA1/2 subgroup, there is 2.5 greater times risk of nodal disease if the US is positive (p-value = 0.001, 95%CI = 2.6–76). In patients without PM, US compared to surgery reached a sensitivity = 88, PPV = 84 and NPV = 86. Conclusion: US is more sensitive in depicting axillary nodal disease in high-risk patients without PM compared to PM patients. Furthermore, there are more false negative US examinations in PM patients, compared to surgery patients.

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Section: Discussionsupporting

confidence: 89%

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients

Pintican

Duma²,

Szep

et al. 2021

JPM

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“…Our results are within the expected range. It is however noticeable that sensitivity for sonography is reported to vary from 15.00 to 85.00% [5,6,37,38]. Elastography may improve sensitivity in this context [39,40].…”

Section: Discussionmentioning

confidence: 98%

“…Sonography as the standard technique for lymph node evaluation varies from 15.00 to 85.00% in terms of sensitivity. The speci city however is stated to be about 90.00 to 95.00% depending on the literature [6,37,38]. We therefore focused on the sensitivity of different medical imaging procedures: sonography, mammography, MRI and CT and aimed to analyze which technique could improve sensitivity in terms of the detection of tumor-in ltrated lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Different Imaging Modalities for Axillary Lymph Node Staging in Breast Cancer Patients to Provide A Personalized and Optimized Therapy Algorithm

Diessner¹,

Anders²,

Herbert³

et al. 2021

Preprint

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Purpose The prognostic importance of lymph node infiltration in breast cancer patients before and after neoadjuvant therapy has increased significantly in recent years. For that reason, the reliable detection of tumor-infiltrated axillary lymph nodes at the time of diagnosis plays a decisive role in further therapy. We therefore focused on the sensitivity of different pretherapeutic imaging modalities (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) in nodal positive breast cancer patients and aimed to find out whether cross-sectional imaging techniques (MRI, CT) could improve sensitivity for pretherapeutic axillary staging compared to conventional imaging such as mammography and sonography. Methods Breast cancer patients with tumor-infiltrated axillary lymph nodes between 2014 and 2020 having a surgery for breast cancer were included in the study. Results All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity.Conclusion We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Considering the increasing importance of neoadjuvant and post-neoadjuvant therapeutic algorithms, the reliable detection of tumor-infiltrated lymph nodes gains increasing importance. Only the safe detection of tumor-infiltrated lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy and thereby allows access to prognosis–improving post-neoadjuvant therapies.

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“…Several previous researchers studied the diagnostic value of US evaluation of axillary nodes. These studies include the studies carried out by Riedel et al [6], Gipponi et al [7], Marino et al [8] and Rukanskienė et al [9].…”

Section: Discussionmentioning

confidence: 99%

Axillary lymph node status in BIRADS 4-5 female patients: can shear wave and strain ultrasound elastography help?

Elmesidy

Eissa

Hamed

et al. 2021

Egypt J Radiol Nucl Med

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Background The status of axillary nodes is a determining factor of management and prognosis for patients having a recent diagnosis of breast cancer. Axillary nodes are usually evaluated by ultrasonography (US) and biopsy, if indicated. Ultrasound-guided sampling and intraoperative or sentinel nodal sampling are available options, however, are invasive and hold risks of potential complications, calling for reliable, non-invasive axillary imaging. In the current prospective study, we assessed the performance of shear wave (SWE) and strain (SE) ultrasound elastography regarding preoperative axillary assessment. Sixty axillary nodes from 60 patients (age 28–65 years, mean 49.88 ± 7.61 SD) were included, all scoring BIRADS 4–5 on sonomammography. Results For US, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 100%, 66.67%, 84.78%, 100%, and 88.33%, respectively. Cortical thickness and vascularity were the most sensitive. For qualitative SWE, indices were 76.92%, 80.95%, 88.24%, 65.38% and 78.33%, respectively. Calculated cut-off for Emax was 59.3 and for Eratio was 4.56, giving statistical indices of 76.9%, 90.5%, 93.75%, 67.86%, and 81.67% for Emax and 76.9%, 100%, 100%, 70% and 85% respectively for Eratio. Both Emax and Eratio were greater for malignant (Emax 81.77 ± 1.904, Eratio 8.95 ± 5.69) than for benign nodes (Emax 37.59 ± 33.37, Eratio 2.5 ± 1.37) (P values < 0.001). For qualitative SE, sensitivity and specificity were 92.31% and 57.14%, while PPV, NPV, and accuracy were 80% each (P values < 0.001). The calculated cut-off value for SR was 3.85, giving indices of 87.2%, 76.2%, 76.19%, 87.18% and 83.33% respectively. Conclusion Adding elastography evaluation to conventional US positively impacts the specificity and accuracy of the preoperative axillary nodal status assessment in patients having newly diagnosed breast cancer.

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Diagnostic accuracy of axillary staging by ultrasound in early breast cancer patients

Cited by 27 publications

References 29 publications

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients

The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients

Evaluation of Different Imaging Modalities for Axillary Lymph Node Staging in Breast Cancer Patients to Provide A Personalized and Optimized Therapy Algorithm

Axillary lymph node status in BIRADS 4-5 female patients: can shear wave and strain ultrasound elastography help?

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