Diagnostic strategy for the assessment of axillary lymph node status in breast cancer

Abstract

The nodal status in breast cancer is a major prognostic factor in terms of survival. It also plays a role in the therapeutic decision-making process. Therefore, the evaluation of lymph node involvement in breast cancer is imperative in establishing a personalized treatment scheme. The sentinel lymph node procedure has proved successful for small breast tumors (T1-T2), limiting axillary lymphadenectomy and its side effects without changing overall survival. Even so, a substantial number of women must undergo axillary lymphadenectomy during a second surgery when the analysis of the sentinel node discloses major nodal involvement. Imaging can improve patient selection, especially those who appear eligible for immediate axillary lymphadenectomy. Ultrasound is able to depict morphological abnormalities in the lymph nodes such as cortical thickening, peripheral vascularization, hilar infiltration and loss of the kidney-shaped appearance of a normal node. When ultrasound is negative, the risk of massive nodal involvement is limited, thus allowing the oncologist to take an approach with the sentinel lymph node procedure. Magnetic resonance imaging (MRI) can also be useful in detecting pathological lymph nodes, particularly with diffusion-weighted MRI sequence.

Role of Ultrasound in the Diagnosis of Lymph Node Status in Axillary Lymph Node Metastases in Breast Cancer undergoing Neoadjuvant Chemotherapy

“…We need a method that can accurately evaluate the axillary status to guide the treatment after NAC.Herrada, J et al believed that ultrasound was the most accurate imaging examination method for the assessment of axillary status at present [7], while klauber-demore, N et al believed that ultrasound was not accurate enough for the assessment of axillary status after neoadjuvant chemotherapy for locally advanced breast cancer [8].Whether SLNB can replace ALND to evaluate the axillary status of patients with clinically negative ALNs is controversial [4,[9][10][11][12].ACOSOG Z1071 test and a number of studies have shown [5,[13][14][15][16]] that AUS combined with SLNB after NAC can reduce the FNR of axillary diagnosis and replace ALND to achieve the purpose of accurate assessment of axillary status.It has also been reported that [17] ultrasound and magnetic resonance imaging(MRI) have the same or more important value in accurately measuring the size of residual lesions of breast cancer after NAC.…”

Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis

“…Axillary nodal status is a major prognostic indicator in early breast cancer. Evaluation of the axillary lymph nodes remains an integral part of staging, prognostication and selection of patients for adjuvant systemic therapy. In the past decade, axillary staging for breast cancer has undergone a paradigm shift towards less invasive methods of assessment and surgical management, and preoperative axillary imaging is now an integral component of pretreatment investigation.…”

“…It has been reported that ultrasound‐guided percutaneous lymph node sampling/biopsy improves selection of patients with a high axillary nodal burden who will benefit from direct ALND. If there is no evidence of lymph node metastasis on ultrasound‐guided percutaneous sampling, SNB remains a necessary component of initial surgical management owing to the low negative predictive values reported for techniques used in percutaneous biopsies of axillary lymph nodes.…”

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

“…Nonetheless, since this type of approach still has a level of invasiveness, however minimal, alternative methods have been tested over time to evaluate the axillary lymph node status without resorting to sentinel lymph node biopsy, even more so after the publication of the results of the Z0011 trial of the American College of Surgeons Oncology Group, which showed how in a subpopulation of patients at an early stage of breast cancer, axillary clearance could be avoided even with a sentinel lymph node biopsy with positive results for micrometastasis. The debate over assessment of the node parameter for breast cancer is still very lively, leading to the search for a diagnostic method that is both effective and noninvasive …”

“…The debate over assessment of the node parameter for breast cancer is still very lively, leading to the search for a diagnostic method that is both effective and noninvasive. [16][17][18] Sonography, [19][20][21] color Doppler imaging, 22,23 and elastography have been examined, even though their diagnostic accuracy indices are not generally high, hence the necessity of an in-depth analysis by means of ultrasound-guided fine-needle aspiration. 24,25 The results thus obtained (although they do not reach the accuracy of a histologic study) are acceptable, but the problem of the invasiveness of the method has not been radically overcome.…”