Diagnostic performance of axillary ultrasound and standard breast MRI for differentiation between limited and advanced axillary nodal disease in clinically node-positive breast cancer patients

Abstract

Preoperative differentiation between limited (pN1; 1–3 axillary metastases) and advanced (pN2–3; ≥4 axillary metastases) nodal disease can provide relevant information regarding surgical planning and guiding adjuvant radiation therapy. The aim was to evaluate the diagnostic performance of preoperative axillary ultrasound (US) and breast MRI for differentiation between pN1 and pN2–3 in clinically node-positive breast cancer. A total of 49 patients were included with axillary metastasis confirmed by US-guided tissue sampling. All had undergone breast MRI between 2008–2014 and subsequent axillary lymph node dissection. Unenhanced T2-weighted MRI exams were reviewed by two radiologists independently. Each lymph node on the MRI exams was scored using a confidence scale (0–4) and compared with histopathology. Diagnostic performance parameters were calculated for differentiation between pN1 and pN2–3. Interobserver agreement was determined using Cohen’s kappa coefficient. At final histopathology, 67.3% (33/49) and 32.7% (16/49) of patients were pN1 and pN2–3, respectively. Breast MRI was comparable to US in terms of accuracy (MRI reader 1 vs US, 71.4% vs 69.4%, p = 0.99; MRI reader 2 vs US, 73.5% vs 69.4%, p = 0.77). In the case of 1–3 suspicious lymph nodes, pN2–3 was observed in 30.4% on US (positive predictive value (PPV) 69.6%) and in 22.2–24.3% on MRI (PPV 75.7–77.8%). In the case of ≥4 suspicious lymph nodes, pN1 was observed in 33.3% on US (negative predictive value (NPV) 66.7%) and in 38.5–41.7% on MRI (NPV 58.3–61.5%). Interobserver agreement was considered good (k = 0.73). In clinically node-positive patients, the diagnostic performance of axillary US and breast MRI is comparable and limited for accurate differentiation between pN1 and pN2–3. Therefore, there seems no added clinical value of preoperative breast MRI regarding nodal staging in patients with positive axillary US.

Three-year follow-up of de-escalated axillary treatment after neoadjuvant systemic therapy in clinically node-positive breast cancer: the MARI-protocol

“…Staging breast cancer patients with FDG-PET/ CT, however, can replace diagnostic imaging with CT, chest X-ray and ultrasound with higher diagnostic accuracy and cost-effectiveness [50,51]. In addition, the diagnostic accuracy of FDG-PET/CT for axillary staging is higher compared to other modalities and therefore essential when tailoring axillary treatment [52][53][54].…”

Attention‐based Deep Learning for the Preoperative Differentiation of Axillary Lymph Node Metastasis in Breast Cancer on DCE‐MRI

“…Such features require human visual assessment and depend on expertise and experience, which may be influenced by individual subjective factors. The results vary greatly among different radiologists 27,28 . Therefore, an accurate and convenient tool should be developed for identifying ALN metastasis.…”

“…The results vary greatly among different radiologists. 27,28 Therefore, an accurate and convenient tool should be developed for identifying ALN metastasis. Radiomics can mine information, which are difficult to recognize with the naked eye.…”

Preoperative axillary nodal staging of invasive lobular breast cancer with ultrasound guided fine needle aspiration in patients with suspicious ultrasound findings versus aspiration in all patients – A retrospective single institutional analysis

“…On the basis of a report on 577 cases, it seems that a negative AXUS can predict for the lack of massive (pN2-pN3) nodal involvement in the majority of cases (NPV 95.5%), but an AXUS+ status cannot really distinguish between pN1 vs pN2-pN3 cases [3,21]. In this respect, AXUS is not worse than standard or dedicated MRI assessment of the axilla [22,23]. Most of the time, greater nodal burden is reflected by pN2 and pN3 categories, only a few studies have concentrated on a definition of >2LNs involved (i.e.…”