Efficacy of physical examination, ultrasound, and ultrasound combined with fine-needle aspiration for axilla staging of primary breast cancer

Feng, Yu; Huang, Rui; He, Yingjian; Lu, Aiping; Fan, Zhaoqing; Fan, Tie; Meng, Qi; Wang, Xinguang; Cao, Wei; Wang, Xing; Xie, Yuntao; Wang, Tianfeng; Li, Jinfeng; Ouyang, Tao

doi:10.1007/s10549-015-3280-z

Cited by 42 publications

(36 citation statements)

References 26 publications

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“…We established a new US criterion (dividing patients into potential malignancy and follow‐up groups) to evaluate the recurrent and nonrecurrent level II and III axillary lymph nodes in this study. Based on this criterion, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, false‐positive rate, false‐negative rate, and area under the receiver operating characteristic curve of axillary US were higher than those reported in previous studies . Another reason for the difference might be that the previous studies did not divide the axillary lymph nodes into various levels, whereas this study differentiated between the US findings for level I and level II and III lymph nodes.…”

Section: Discussioncontrasting

confidence: 58%

“…Based on this criterion, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, false-positive rate, false-negative rate, and area under the receiver operating characteristic curve of axillary US were higher than those reported in previous studies. 4,[14][15][16] Another reason for the difference might be that the previous studies 4, [14][15][16] did not divide the axillary lymph nodes into various levels, whereas this study differentiated between the US findings for level I and level II and III lymph nodes. Moreover, ALND was performed in all cases in our study, which was different from the studies by Snider et al 8 and Susini et al, 6 in which sentinel lymph node dissection was used.…”

Section: Discussionmentioning

confidence: 68%

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Ultrasound Imaging for Detecting Metastasis to Level II and III Axillary Lymph Nodes after Axillary Lymph Node Dissection for Invasive Breast Cancer

Lin

Xiang

et al. 2019

J of Ultrasound Medicine

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Objectives The diagnostic value of axillary ultrasound (US) for level II and III axillary lymph node metastasis after axillary lymph node dissection for invasive breast cancer is currently not clear. The objectives of this study were to retrospectively analyze the diagnostic value of axillar US for level II and III axillary lymph node metastasis and compare it with palpation and to analyze the US features of level II and III axillary lymph nodes that are predictive of metastatic recurrence during follow‐up. Methods Cases with level II or III axillary lymph nodes detected by US between January 2005 and December 2017 at a cancer center were divided into 2 groups according to a retrospective analysis of US findings: potential malignancy group and follow‐up group. Biopsy was performed in all patients in the potential malignancy group. In the follow‐up group, the patients were followed for at least 2 years, and biopsy was performed if suspicious US features were detected. Results The 401 enrolled cases were followed by axillary US and physical examination (PE) for comparison. Finally, 55 axillary metastases were pathologically confirmed (14%). The sensitivity, specificity, and area under the receiver operating characteristic curve for axillary US were 92.7%, 93.9%, and 0.933, respectively, and the corresponding values for PE were 49.1%, 91.3%, and 0.702 (P < .001). An increase in the major or minor axis diameter of the lymph nodes of greater than 2 mm, a Solbiati index value of less than 1.5, and the presence of new suspicious lesions in other regions were significant predictors of lymph node metastasis based on the US findings (P = .013, .006, .015, and .036). Conclusions Axillary is helpful in the follow‐up of level II and III axillary lymph nodes after axillary lymph node dissection for invasive breast cancer and can detect cancer recurrence earlier than PE.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 68%

Ultrasound Imaging for Detecting Metastasis to Level II and III Axillary Lymph Nodes after Axillary Lymph Node Dissection for Invasive Breast Cancer

Lin

Xiang

et al. 2019

J of Ultrasound Medicine

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“…The sensitivity and specificity of PE have been shown to be 30% and 93% in one study, and others have demonstrated a false‐positive rate of 53% . The use of AUS with PE has been shown to improve the accuracy of pretreatment nodal evaluation, with the sensitivity and specificity being 59% and 89%, respectively . In the present study, AUS identified abnormal appearing LNs in 63% (76/120) of patients with a negative PE, of which 70% (53/76) were biopsy‐proven positive.…”

Section: Discussionsupporting

confidence: 52%

“…11 The use of AUS with PE has been shown to improve the accuracy of pretreatment nodal evaluation, with the sensitivity and specificity being 59% and 89%, respectively. 12,13 In the present study, AUS identified Characteristics of metastatic appearing LNs on AUS include cortical thickening, rounding of node with loss of fatty hilum and loss of normal architecture and have been shown to have a high correlation with metastatic disease on final pathology. 16,17 However, a multicenter study showed that 29% of patients with normal appearing LNs by AUS or with negative biopsy results still had positive LNs on final pathology.…”

Section: Re Sultsmentioning

confidence: 67%

Does use of axillary ultrasound in clinically node‐negative patients receiving neo‐adjuvant systemic therapy for breast cancer lead to surgical overtreatment?

Horwood

Hayek

et al. 2019

Breast J

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Increased use of neo‐adjuvant chemotherapy (NAC) for breast cancer has raised uncertainty regarding staging of the axilla, particularly for patients with a clinically negative axillary physical examination (PE). We sought to determine whether axillary ultrasound (AUS) prior to NAC to identify occult nodal disease is beneficial in patients with a clinically negative examination by evaluating the difference in nodal burden on final pathology in those with abnormal vs normal AUS. A retrospective review of an institutional cancer registry identified patients who underwent NAC for breast cancer and had a pretreatment AUS. Differences in the number of positive lymph nodes (PLN) in patients with a normal axillary PE and abnormal vs normal AUS prior to NAC were determined. A total of 120 patients who received NAC had a negative axillary PE prior to treatment. Fifty‐three had an abnormal AUS and biopsy‐proven lymph node (LN) involvement. In patients with an abnormal AUS, median number of PLNs at surgery was 1 vs 0 for those with a normal AUS (mean difference of 2.12, P < .0001). Of those patients with an abnormal AUS and biopsy‐proven LN involvement, 87% underwent axillary lymph node dissection (ALND) and nearly half had no PLN on final pathology (N = 23, 43%). Patients with a clinically negative axilla and an abnormal AUS were more likely to have PLN at the time of surgery. However, almost half of those patients had no residual LN involvement. Routine AUS prior to NAC may lead to more extensive surgical management of the axilla.

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“…2 They performed a retrospective study of 3,781 breast cancer patients and calculated the sensitivity, specificity, PPV, NPV, and accuracy for PE, US, and US-FNAC, respectively. Abnormal axillary nodes under US were detected in 1,152 cases, among which 821 were proven to have positive nodes by FNAC.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of USG and USG guided FNAC axilla in predicting nodal metastasis in a clinically lymph node negative cancer breast patient

et al. 2016

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INTRODUCTIONBreast malignancies are the second most common cause of cancer-related mortality among women. As the size of the primary breast cancer increases, some cancer cells are shed into cellular spaces and transported via the lymphatic network of the breast to the regional lymph nodes, especially the axillary lymph nodes. Cancer cells may grow through the lymph node capsule and fix to contiguous structures in the axilla, including the chest wall. Typically, axillary lymph nodes are involved sequentially from the low (level I) to the central (level II) to the apical (level III) lymph node groups. Approximately 95% of the women who die of breast cancer have distant metastases, and traditionally the most important prognostic correlate of disease-free and overall survival was axillary lymph node status. Women with node-negative disease had less than a 30% risk of recurrence, compared with as much as a 75% risk for women with node-positive disease. 1,2The status of axillary lymph node metastasis, in addition to being the most important prognostic factor in this group of patients, has a critical place in the management ABSTRACT Background: Breast malignancies are the second most common cause of cancer-related mortality among women. As the size of the primary breast cancer increases, some cancer cells are shed into cellular spaces and transported via the lymphatic network of the breast to the regional lymph nodes, especially the axillary lymph nodes. Objective of the study was to determine the accuracy of USG and US-FNAC in detecting lymph node metastasis in a clinically lymph node negative CA Breast patient. Methods: This prospective study was conducted on 40 consecutive patients with biopsy proven breast cancer with clinically negative axilla, who had attending the OPD or IPD in our department of surgery, Swaroop Rani Nehru Hospital, Allahabad, during the period of 2014 to 2015. All of these patients were planned to undergo surgery (breast conservation or modified radical mastectomy with axillary clearance). Results: Sensitivity of the study = 97.77%, specificity = 25%, positive predictive value =92.01%, negative predictive value =50%, diagnostic accuracy =90%. Conclusions: Using axillary ultrasound and selective US-FNAC is a rapid, non-morbid method of staging the axilla in newly diagnosed breast cancer patients and should become a routine part of patient care because it can spare many patients particularly those who are undergoing axillary dissection.

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Efficacy of physical examination, ultrasound, and ultrasound combined with fine-needle aspiration for axilla staging of primary breast cancer

Cited by 42 publications

References 26 publications

Ultrasound Imaging for Detecting Metastasis to Level II and III Axillary Lymph Nodes after Axillary Lymph Node Dissection for Invasive Breast Cancer

Ultrasound Imaging for Detecting Metastasis to Level II and III Axillary Lymph Nodes after Axillary Lymph Node Dissection for Invasive Breast Cancer

Does use of axillary ultrasound in clinically node‐negative patients receiving neo‐adjuvant systemic therapy for breast cancer lead to surgical overtreatment?

The accuracy of USG and USG guided FNAC axilla in predicting nodal metastasis in a clinically lymph node negative cancer breast patient

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