Preoperative Axillary Ultrasound Helps in the Identification of a Limited Nodal Burden in Breast Cancer Patients

Abstract

Since the Z0011 trial, the clinical evaluation of axillary status has been redirected to predicting nodal tumor burden rather than nodal metastases. Our study aimed to evaluate the value of clinicopathological factors and axillary ultrasound (US) for the prediction of a high nodal burden (≥3 metastatic lymph nodes) in breast cancer patients. A total of 532 consecutive patients who underwent preoperative axillary US and subsequent surgery for clinical T1–2 breast cancer with a final pathologic analysis were included. Clinical and pathologic variables were retrospectively evaluated. Univariate and multivariate statistical analyses were performed to identify the variables that were associated with a high nodal burden. Among the 532 patients, 110 (20.7%) had a high axillary nodal burden and 422 (79.3%) had a limited nodal burden. The multivariate analysis showed that suspicious axillary US findings (P < 0.001), clinical T2 stage (P = 0.011), the presence of lymphovascular invasion (P < 0.001), and estrogen receptor positivity (P < 0.001) were significantly associated with a high nodal burden. Patients with negative axillary US findings seldom had a high nodal burden, with a negative predictive value of 93.0% (294/316). Patients with suspicious axillary US findings, clinical T2 stage, lymphovascular invasion, and estrogen receptor positivity are more likely to have a high nodal burden, which may provide additional information for the treatment plan of breast cancer patients. Preoperative axillary US helps identify a limited nodal burden in breast cancer patients and has implications for axillary lymph node dissection and adjuvant treatment.

Prediction of high nodal burden in invasive breast cancer by quantitative shear wave elastography

“…In this analysis, high nodal burden group in IBC is associated with clinicopathological criteria, ultrasound characteristics, and tumor or ALN stiffness evaluated by SWE. LVI of the primary breast tumor is regarded as a well-known independent risk factor for axillary nodal metastases (16), the results of our research have shown that LVI has been correlated with an high nodal burden that confirms earlier issued articles (17,18), but the findings of LVI cannot be precisely provided until post-surgery pathology.…”

Automated Versus Handheld Breast Ultrasound for Evaluating Axillary Lymph Nodes in Patients With Breast Cancer

“…Moreover, the sensitivity and specificity of ABUS in predicting heavy nodal metastases were statistically similar to those of HHUS and those previously reported [ 17 24 ]. Among the diagnostic performance metrics, the NPV of ABUS was the highest, similar to that of HHUS and comparable to that previously reported (93%) by Luo et al [ 25 ]. This high NPV for heavy nodal burden metastases has implications in axillary management.…”