Sensitivity, Specificity and Accuracy of Ultrasound in Diagnosis of Breast Cancer Metastasis to the Axillary Lymph Nodes in Chinese Patients

Zhang, Yanna; Wang, Changjun; Xu, Ying; Zhu, Qingli; Zhou, Yidong; Zhang, Jing; Mao, Feng; Jiang, Yuxin; Sun, Qiang

doi:10.1016/j.ultrasmedbio.2015.03.024

Cited by 28 publications

(30 citation statements)

References 16 publications

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“…It can distinguish benign and malignant lymph nodes predominantly based on the size, morphologic characteristics, vascular pattern, and other features. 11,14 In this study, the results demonstrated that metastatic axillary lymph nodes had a longer longitudinal diameter and higher longitudinal-to-transverse diameter ratio, which means that the shape of the metastatic nodes tended to be round rather than oval. Compared with nonmetastatic axillary lymph nodes, metastatic nodes had a thicker cortex and a more abundant blood supply.…”

Section: Discussionmentioning

confidence: 58%

“…Conventional US has been used widely for the assessment of axillary lymph nodes in breast cancer. It can distinguish benign and malignant lymph nodes predominantly based on the size, morphologic characteristics, vascular pattern, and other features . In this study, the results demonstrated that metastatic axillary lymph nodes had a longer longitudinal diameter and higher longitudinal‐to‐transverse diameter ratio, which means that the shape of the metastatic nodes tended to be round rather than oval.…”

Section: Discussionmentioning

confidence: 59%

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Role of Elastography in Axillary Examination of Patients With Breast Cancer

Chang

Wei

Junni

et al. 2018

J of Ultrasound Medicine

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Elastography can improve the sensitivity when disjunctively combined with conventional US for diagnosis of the axillary lymph node status. Despite the low sensitivity, the conjunctive combination of US and elastography can improve the positive predictive value on a large scale. Elastography is a useful adjuvant tool in addition to conventional US for the preoperative assessment of axillary lymph nodes in patients with breast cancer.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 59%

Role of Elastography in Axillary Examination of Patients With Breast Cancer

Chang

Wei

Junni

et al. 2018

J of Ultrasound Medicine

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“…Speci city was calculated as the proportion of patients with no pathologic metastatic lymph node who had a normal lymph node in preoperative ultrasound images. Accuracy was calculated as the proportion of patients whose axillary lymph node status was correctly predicted by ultrasound [13]. Statistical software was analyzed by SPSS 24.0 software, and P < 0.05 was set as statistically different.…”

Section: Discussionmentioning

confidence: 99%

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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“…Lee et al reported sensitivity, specificity, and accuracy of 54%, 85%, and 68%, respectively, in a study of 224 axillary LNs from patients with breast cancer. A retrospective study of 1049 patients with breast cancer found sensitivity, specificity, and accuracy of 69%, 82%, and 77% . The main limitation in the evaluation of LNs using B‐mode images is variability due to the radiologist's experience.…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective study of 1049 patients with breast cancer found sensitivity, specificity, and accuracy of 69%, 82%, and 77%. 26 The main limitation in the evaluation of LNs using B-mode images is variability due to the radiologist's experience. To improve the accuracy of a B-mode evaluation, previous studies added Doppler US for an LN evaluation.…”

Section: Discussionmentioning

confidence: 99%

Performance of Molecular Lymphosonography for Detection and Quantification of Metastatic Involvement in Sentinel Lymph Nodes

Nam

Stapp

Liu

et al. 2018

J of Ultrasound Medicine

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Objectives To assess the performance of molecular lymphosonography with dual‐targeted microbubbles in detecting and quantifying the metastatic involvement in sentinel lymph nodes (SLNs) using a swine melanoma model. Methods Targeted microbubbles were labeled with P‐selectin and αVβ3‐integrin antibodies. Control microbubbles were labeled with immunoglobulin G antibodies. First lymphosonography with Sonazoid (GE Healthcare, Oslo, Norway) was used to identify SLNs. Then dual‐targeted and control microbubbles were injected intravenously to detect and quantify metastatic disease in the SLNs. Distant non‐SLNs were imaged as benign controls. All evaluated lymph nodes (LNs) were surgically removed, and metastatic involvement was characterized by a histopathologic analysis. Two radiologists blinded to histopathologic results assessed the baseline B‐mode images of LNs, and the results were compared to the histologic reference standard. The mean intensities of targeted and control microbubbles within the examined LNs were measured and compared to the LN histologic results. Results Thirty‐five SLNs and 34 non‐SLNs from 13 Sinclair swine were included in this study. Twenty‐one SLNs (62%) were malignant, whereas 100% of non‐SLNs were benign. The sensitivity of B‐mode imaging for metastatic LN diagnosis for both readers was relatively high (90% and 71%), but the specificity was very poor (50% and 58%). The sensitivity and specificity of molecular lymphosonography for metastatic LN detection were 91% and 67%, respectively. The mean intensities from dual‐targeted microbubbles correlated well with the degree of metastatic LN involvement (r = 0.6; P < 0.001). Conclusions Molecular lymphosonography can increase the specificity of metastatic LN detection and provide a measure to quantify the degree of metastatic involvement.

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Sensitivity, Specificity and Accuracy of Ultrasound in Diagnosis of Breast Cancer Metastasis to the Axillary Lymph Nodes in Chinese Patients

Cited by 28 publications

References 16 publications

Role of Elastography in Axillary Examination of Patients With Breast Cancer

Role of Elastography in Axillary Examination of Patients With Breast Cancer

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

Performance of Molecular Lymphosonography for Detection and Quantification of Metastatic Involvement in Sentinel Lymph Nodes

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