Strategy for the accurate preoperative evaluation of the number of metastatic axillary lymph nodes in breast cancer

Imai, Nao; Kitayama, Mika; Shibahara, Akiko; Bessho, Yuri; Shibusawa, Mai; Noro, Aya; Inakami, Keiko; Hanamura, Noriko; Imai, Hiroshi; Ogawa, Tomoko

doi:10.1016/j.asjsur.2018.03.003

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…In our study, the optimal cut-off value of cortical thickness was 3.3 mm. This is different from the results of Chen and Imai et al whose results are 3 mm [ 22 , 31 ].…”

Section: Discussioncontrasting

confidence: 96%

“…In terms of diagnosing lymph node status, this study demonstrated that LN metastasis of breast cancer is usually orderly, and SLN usually located at level I, which support the results of Kalli et al, namely, breast cancer cells spread progressively and orderly along the lymphatic drainage system, with level I first metastasis in most cases [ 30 ]. Both long-axis diameter and short-axis diameter of the metastasis SLN are significantly longer than that of the non-metastasis SLN, which is consistent with previous research results [ 31 , 32 ]. As for the short-axis diameter, it is recommended to distinguish between benign and malignant LNs in the RECIST 1.1 [ 33 ].…”

Section: Discussionsupporting

confidence: 92%

“…Our study indicated that 9.1 mm was the best short-axis diameter cut-off value. Previous researchers have used short-axis diameter ≥ 10 mm as the cut-off value for diagnosing metastatic ALN [ 31 , 37 ]. In addition, the ratio of long-/short-axis on the image could also indicate ALN involvement.…”

Section: Discussionmentioning

confidence: 99%

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Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis

Zhu

et al. 2021

BMC Med Imaging

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Introduction Accurately assessing axillary lymph node (ALN) status in breast cancer is vital for clinical decision making and prognosis. The purpose of this study was to evaluate the predictive value of sentinel lymph node (SLN) mapped by multidetector-row computed tomography lymphography (MDCT-LG) for ALN metastasis in breast cancer patients. Methods 112 patients with breast cancer who underwent preoperative MDCT-LG examination were included in the study. Long-axis diameter, short-axis diameter, ratio of long-/short-axis and cortical thickness were measured. Logistic regression analysis was performed to evaluate independent predictors associated with ALN metastasis. The prediction of ALN metastasis was determined with related variables of SLN using receiver operating characteristic (ROC) curve analysis. Results Among the 112 cases, 35 (30.8%) cases had ALN metastasis. The cortical thickness in metastatic ALN group was significantly thicker than that in non-metastatic ALN group (4.0 ± 1.2 mm vs. 2.4 ± 0.7 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of > 3.3 mm (OR 24.53, 95% CI 6.58–91.48, P < 0.001) had higher risk for ALN metastasis. The best sensitivity, specificity, negative predictive value(NPV) and AUC of MDCT-LG for ALN metastasis prediction based on the single variable of cortical thickness were 76.2%, 88.5%, 90.2% and 0.872 (95% CI 0.773–0.939, P < 0.001), respectively. Conclusion ALN status can be predicted using the imaging features of SLN which was mapped on MDCT-LG in breast cancer patients. Besides, it may be helpful to select true negative lymph nodes in patients with early breast cancer, and SLN biopsy can be avoided in clinically and radiographically negative axilla.

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“…In our study, the optimal cut-off value of cortical thickness was 3.3 mm. This is different from the results of Chen and Imai et al whose results are 3 mm [ 22 , 31 ].…”

Section: Discussioncontrasting

confidence: 96%

Section: Discussionsupporting

confidence: 92%

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Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis

Zhu

et al. 2021

BMC Med Imaging

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“…This proposed cutoff value was supported by but lower than that of March's finding in CT scan, which accepted 10 mm of short-axis for diagnosing lymph node metastasis in breast cancer (32). A recent study by Imai, N. and colleagues showed that, by CT scan, patients with ≥3 nodes meeting the criterion of both having a long-axis diameter ≥10 mm and a short-axis diameter ≥5 mm could be diagnosed with ALN metastasis (35). In our study, the average long-axis diameter in metastatic ALN was longer than that in non-metastatic counterparts by MDCT scan, however, no statistically significant difference was found between these two sets of ALN.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Preoperative Multidetector-Row Computed Tomography for Axillary Lymph Nodes Metastasis in Patients With Breast Cancer

et al. 2019

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Introduction: Axillary lymph nodes (ALN) status is an essential component in tumor staging and treatment planning for patients with breast cancer. The aim of present study was to evaluate the predictive value of preoperative multidetector-row computed tomography (MDCT) for ALN metastasis in breast cancer patients.Methods: A total of 148 cases underwent preoperative MDCT examination and ALN surgery were eligible for the study. Logistic regression analysis of MDCT variates was used to estimate independent predictive factors for ALN metastasis. The prediction of ALN metastasis was determined with MDCT variates through receiver operating characteristic (ROC) analysis.Results: Among the 148 cases, 61 (41.2%) cases had ALN metastasis. The cortical thickness in metastatic ALN was significantly thicker than that in non-metastatic ALN (7.5 ± 5.0 mm vs. 2.6 ± 2.8 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of >3 mm (OR: 12.32, 95% CI: 4.50–33.75, P < 0.001) and non-fatty hilum (OR: 5.38, 95% CI: 1.51–19.19, P = 0.009) were independent predictors for ALN metastasis. The sensitivity, specificity and AUC of MDCT for ALN metastasis prediction based on combined-variated analysis were 85.3%, 87.4%, and 0.893 (95% CI: 0.832–0.938, P < 0.001), respectively.Conclusions: Cortical thickness (>3 mm) and non-fatty hilum of MDCT were independent predictors for ALN metastasis. MDCT is a potent imaging tool for predicting ALN metastasis in breast cancer. Future prospective study on the value of contrast enhanced MDCT in preoperative ALN evaluation is warranted.

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“…After AUS and US-FNAC, core needle biopsy (CNB) is recommended as the preoperative assessment. In daily practice, various methods are introduced for cytological preparation, such as conventional smear (CS), liquid-based preparation (LBP) and cell block [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , <...>…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Fine-Needle Aspiration Cytology and Core-Needle Biopsy in the Assessment of the Axillary Lymph Nodes in Breast Cancer—A Meta-Analysis

et al. 2020

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Background: The present study aims to evaluate the diagnostic accuracy between ultrasonography-guided fine-needle aspiration cytology (US-FNAC) and core needle biopsy (CNB) of axillary lymph nodes (ALNs) in patients with breast cancer through a meta-analysis and a diagnostic test accuracy (DTA) review. Methods: The present meta-analysis and DTA review included 67 eligible studies. The diagnostic accuracy of various preoperative assessments, including US-FNAC and CNB, was evaluated for ALNs assessments in patients with breast cancer. In addition, a subgroup analysis based on methods of cytologic preparation was performed. In the DTA review, the sensitivity, specificity, diagnostic odds ratio (OR) and area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated. Results: The diagnostic accuracy of the preoperative assessments of ALNs was 0.850 (95% confidence interval (CI) 0.833–0.866) for patients with breast cancer. The diagnostic accuracy of CNB was significantly higher than that of US-FNAC (0.896, 95% CI 0.844–0.932 vs. 0.844, 95% CI 0.825–0.862; p = 0.044 in a meta-regression test). In the subgroup analysis based on cytologic preparation, the diagnosis accuracies were 0.860, 0.861 and 0.859 for the methods of conventional smear, liquid-based preparation and cell block, respectively. In the DTA review, CNB showed higher sensitivity than US-FNAC (0.849 vs. 0.760). However, there was no difference in specificity between US-FNAC and CNB (0.997 vs. 1.000). US-FNAC with liquid-based preparation and CNB showed the highest diagnostic OR and AUC on the SROC, respectively. Conclusion: Both US-FNAC and CNB are useful in preoperative assessments of ALNs in patients with breast cancer. Although the most sensitive test was found to be CNB in this study, there was no difference in specificity between various preoperative evaluations and the application of US-FNAC or CNB may be impacted by various factors.

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Strategy for the accurate preoperative evaluation of the number of metastatic axillary lymph nodes in breast cancer

Abstract: Although we can pick up LNs that are likely to have metastasis on CT/US, it was impossible to accurately predict the number of metastases on CT/US. However, bedside-FNAC of suspicious LNs could accurately predict the number of metastases.

Cited by 5 publications

References 19 publications

Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis

Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis

Predictive Value of Preoperative Multidetector-Row Computed Tomography for Axillary Lymph Nodes Metastasis in Patients With Breast Cancer

Diagnostic Accuracy of Fine-Needle Aspiration Cytology and Core-Needle Biopsy in the Assessment of the Axillary Lymph Nodes in Breast Cancer—A Meta-Analysis

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