Lymph Node Imaging in Patients with Primary Breast Cancer: Concurrent Diagnostic Tools

Marino, Maria Adele; Avendaño, Daly; Zapata, Pedro Darío; Riedl, Christopher C.; Pinker, Katja

doi:10.1634/theoncologist.2019-0427

Cited by 110 publications

(77 citation statements)

References 72 publications

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“…Our data showed that US had 66.24% sensitivity, 76.62% speci city and 73.87% overall accuracy in the diagnosis of breast cancer axillary lymph metastases, which were consistent with the reported data [15][16][17]. According to the literature, a normal lymph usually shows as a reniform shape, uniformly hypoechoic cortex with a maximal thickness less than 3 mm, smooth margins, and intact central fatty hilum [18]. On the contrary, suspicious ndings of ALN are cortical thickness greater than 2.5-3.0 mm, focal cortical lobulation, loss of the fatty hilum, a round shape, and abnormal cortical blood ow [19].…”

Section: Discussionsupporting

confidence: 90%

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

Liu

Wang

et al. 2020

Preprint

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Background: Axillary lymph node dissection can be avoided in early stage breast cancer patients with negative sentinel lymph node biopsy. However, the possibility of avoiding axillary surgery in patients without axillary lymph node metastasis (ALNM) by preoperative imaging is still under exploration. Thus, the objectives of this study were to investigate the high-risk factors of false negative of ALNM diagnosed by preoperative ultrasound (US) and to find out who could be avoided axillary surgery in the US negative ALNM patients.Methods: This study retrospectively analyzed 3,361 patients with primary early breast cancer diagnosed in the Breast Center of the Fourth Hospital of Hebei Medical University from January 2010 to December 2012. All patients had undergone routine preoperative US and then axillary lymph node dissected. This study investigated the clinicopathological features of axillary lymph node (ALN) negative patients diagnosed by preoperative US and its correlation with prognosis. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 2,357 patients. Results: The sensitivity, specificity and accuracy of axillary US in this cohort were 66.24%, 76.62% and 73.87%. The proportion of patients in the false negative group was higher than that in true negative in the group of age < 50 years old (P = 0.002), tumor size > 2cm (P = 0.008), estrogen receptor (ER) positive (P = 0.005), progesterone receptor (PR) high expression (P = 0.007), nuclear-associated antigen Ki-67 (Ki-67) >20% (P = 0.030), visible vascular tumor thrombus (P < 0.001) and histological grade>2 (P < 0.001). Prognostic analysis of false negative and true negative ultrasonographic diagnosis of ALN metastasis: when ALNM was not found by preoperative ultrasound, there was no significant difference in patients with ALNM≤3 compared with patients without lymph node metastasis in patients of age ≥ 50 years old, tumor size ≤ 2cm, Ki-67 ≤ 20%, or histological grade ≤ 2. Conclusion: The surgery of ALN may be avoided for the preoperative US diagnosed ALNs negative in early breast cancer patients who had advanced age, small tumor size, low expression of Ki-67 and low histological grade.

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Section: Discussionsupporting

confidence: 90%

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

Liu

Wang

et al. 2020

Preprint

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“…Ultrasound imaging features of the axillary lymphadenopathy included: maximal dimension on long axis, and cortex width of the largest lymph node on the vaccinated arm side. In this regard, it should be mentioned though, that a lack of consensus exists for axillary node size assessment on ultrasound [12] , while focal or diffuse thickening greater than 3 mm cortical thickness are considered proper parameters 13 , 14 , 15 . Measurements were obtained by a single reader (RF, certified fellowship-trained breast radiologist, with 8 years of experience in breast imaging).…”

Section: Methodsmentioning

confidence: 99%

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

et al. 2021

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Introduction: Following vaccination of Israeli population with Pfizer-BioNTech COVID-19 Vaccine, an unusual increase in axillary-lymphadenopathy was noted. This study assesses the rate and magnitude of this trend from breast-imaging standpoint. Materials and Methods: Participants undergoing breast-imaging, in whom isolated axillary-lymphadenopathy was detected were questioned regarding SARS-CoV-2 vaccine to the ipsilateral arm. Patients’ and imaging characteristics were statistically compared. In order to perform a very short-term follow-up, twelve healthy vaccinated medical staff-members, underwent axillary-ultrasound shortly after the second dose, and follow-up. Results: Axillary-lymphadenopathy attributed to vaccination was found in 163 women undergoing breast-imaging, including BRCA -carriers. During the study, number of detected lymphadenopathies increased by 394% (p=0.00001) in comparison with previous two consecutive years. Mean cortical-thickness of abnormal lymph-nodes after second dose vaccination was 5±2 mm. Longer lymph-node diameter after second vaccination was noted (from 15±5 mm, to 18±6 mm, p=0.005). In the subgroup of medical staff members, following trends were observed: in patients with positive antibodies, lymph-node cortical-thickness was larger than patients with negative serology (p=0.03); lymph-node cortical-thickness decreased in 4-5 weeks follow-up (p=0.007). Lymphadenopathy was evident on mammography in only 49% of cases. Discussion: Vaccine-associated lymphadenopathy is an important phenomenon with great impact on breast-imaging clinic workload. Results suggest the appearance of cortical thickening shortly after both doses. Positive serology is associated with increased lymph-node cortical-thickness. In asymptomatic vaccinated women with ipsilateral axillary-lymphadenopathy as the only abnormal finding, radiological follow-up is probably not indicated. BRCA -carriers, although at higher risk for breast-cancer, should probably receive the same management as average-risk patients.

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“…Non-invasive prediction of lymph node status for patients with early-stage invasive breast cancer based on a morphological feature from ultrasound images for local disease control. In the past few years, sentinel node biopsy (SNB) has developed as an alternative to ALND and has become the regular treatment for axillary evaluation in clinically negative patients (4)(5)(6). The SNB is a minimally invasive method and has a significantly lower incidence rate of complications such as lymphedema, numbness, pain, and shoulder impairment than ALND (7,8).…”

Section: Original Articlementioning

confidence: 99%

Non-invasive prediction of lymph node status for patients with early-stage invasive breast cancer based on a morphological feature from ultrasound images

Jiang¹,

Su²,

Zhao³

et al. 2021

Quant Imaging Med Surg

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Background: This study aimed to estimate the value of a morphological feature on ultrasound (US) for preoperative diagnosis of axillary lymph node (ALN) status in patients with early-stage invasive breast cancer (ESIBC).Methods: In this retrospective work, a total of 239 ESIBC patients, were recruited, and their preoperative US images and postoperative pathology results were collected. The relationship between US images based on morphological features and ALN metastasis was investigated. The tumor circularity and US-reported ALN status were developed as a nomogram to predict the ALN status.Results: Among the 239 participants, 82 (34.31%) had ALN metastasis, and 157 (65.69%) did not. There was a statistically significant difference in tumors between participants diagnosed with and without ALN metastasis. The median value was 0.47 vs. 0.62 (P<0.001) in the training group, respectively, and the value was 0.50 vs. 0.60 (P<0.001) in the validation group, respectively. The clinical model nomogram was shown to have high efficiency in predicting ALN status among our research population. The area under the curve (AUC) was 0.89 in the training group and 0.90 in the validation group and the accuracy was 85.79% and 81.63%, respectively. Conclusions:The clinical model nomogram based on tumor circularity and US-reported ALN status is a non-invasive approach for ALN metastasis prediction in ESIBC patients with high efficacy.

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Lymph Node Imaging in Patients with Primary Breast Cancer: Concurrent Diagnostic Tools

Cited by 110 publications

References 72 publications

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

COVID-19 Vaccination Induced Lymphadenopathy in a Specialized Breast Imaging Clinic in Israel: Analysis of 163 cases

Non-invasive prediction of lymph node status for patients with early-stage invasive breast cancer based on a morphological feature from ultrasound images

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