The impact of axillary ultrasound with biopsy in overtreatment of early breast cancer

Riego, Javier del; Diaz-Ruiz, Maria Jesus; Teixidó, Milagros; Ribé, Judit; Vilagran, Mariona; Canales, Lidia; Sentís, Melcior; Vallès-Osona-Bages, Grup de Mama

doi:10.1016/j.ejrad.2017.11.018

Cited by 14 publications

(10 citation statements)

References 26 publications

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“…In addition, the initial method of detecting metastatic LNs would have little influence on patient outcomes if their nodal status is fixed based on the final pathological examination. That assumption is parallel to the previous attempts to expand the Z0011 strategy based on preoperative imaging and/or image-guided cytology [12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 76%

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

Jung

Kim

et al. 2020

Cancers

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The Z0011 trial demonstrated that axillary lymph node dissection (ALND) could be omitted in spite of 1–2 metastatic sentinel lymph nodes. This study aimed to validate the results on a population-based database. The Surveillance, Epidemiology, and End Results (SEER) database was searched for patients comparable to the Z0011 participants. The type of axillary surgery was estimated using the total number of examined axillary lymph nodes (ALNs). Breast cancer-specific mortality (BCSM) was compared between patients with ≥10 ALNs (the sentinel lymph node dissection (SLND) and ALND group, or “SLND + ALND group”) and patients with one or two ALNs (the “SLND group”). During 2010–2015, the SEER database included 7077 and 6620 patients categorized in the SLND group and the SLND + ALND group, respectively. Death was observed for 515 patients (7.3%) in the SLND group and 589 patients (8.9%) in the SLND + ALND group based on a median follow-up of 41 months. After propensity-score matching, the adjusted hazard ratio for BCSM in the SLND group (vs. the SLND + ALND group) was 1.038 (95% confidence interval: 0.798–1.350). Regardless of the SLND criteria, the outcomes were not significantly different between the two groups. This retrospective cohort study of Z0011-comparable patients revealed that ALND could be omitted based on the Z0011 strategy, even among patients with ≤2 dissected ALNs.

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Section: Discussionmentioning

confidence: 76%

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

Jung

Kim

et al. 2020

Cancers

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“…Axillary US alone has a relatively low NPV and sensitivity to be useful as a predictor of axillary nodal burden [83,84]. When combined with needle biopsy, however, the sensitivity improves from 61% to 79% in a meta-analysis of 21 studies [54,62,85]. US-guided core needle biopsy was superior to US-guided FNA in a meta-analysis of 1,353 patients with newly diagnosed invasive breast carcinoma, with a reported sensitivity of 88% for core biopsy and 74% for FNA [86].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Imaging of the Axilla

Le-Petross¹,

Slanetz²,

Lewin³

et al. 2022

Journal of the American College of Radiology

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“…In the temporal validation cohort, the radiomics model also demonstrated the AUC value of 0.77 for predicting the probability of high axillary tumor burden. Previous studies took advantage of axillary ultrasound to identify axillary metastasis preoperatively for breast cancer patients ( 10 , 48 ). However, axillary ultrasound does not accurately differentiate between low and high axillary tumor burden ( 49 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, after the ACOSOG Z0011 trial, the assessment of lymph node status is no longer limited to axillary metastasis but more focused on the axillary tumor burden that indicates the extent of lymph node involvement ( 10 ). If the patient has four or more positive ALNs, that is considered as high axillary tumor burden.…”

Section: Introductionmentioning

confidence: 99%

Contrast-Enhanced Spectral Mammography-Based Prediction of Non-Sentinel Lymph Node Metastasis and Axillary Tumor Burden in Patients With Breast Cancer

Guo

et al. 2022

Front. Oncol.

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PurposeTo establish and evaluate non-invasive models for estimating the risk of non-sentinel lymph node (NSLN) metastasis and axillary tumor burden among breast cancer patients with 1–2 positive sentinel lymph nodes (SLNs).Materials and MethodsBreast cancer patients with 1–2 positive SLNs who underwent axillary lymph node dissection (ALND) and contrast-enhanced spectral mammography (CESM) examination were enrolled between 2018 and 2021. CESM-based radiomics and deep learning features of tumors were extracted. The correlation analysis, least absolute shrinkage and selection operator (LASSO), and analysis of variance (ANOVA) were used for further feature selection. Models based on the selected features and clinical risk factors were constructed with multivariate logistic regression. Finally, two radiomics nomograms were proposed for predicting NSLN metastasis and the probability of high axillary tumor burden.ResultsA total of 182 patients [53.13 years ± 10.03 (standard deviation)] were included. For predicting the NSLN metastasis status, the radiomics nomogram built by 5 selected radiomics features and 3 clinical risk factors including the number of positive SLNs, ratio of positive SLNs, and lymphovascular invasion (LVI), achieved the area under the receiver operating characteristic curve (AUC) of 0.85 [95% confidence interval (CI): 0.71–0.99] in the testing set and 0.82 (95% CI: 0.67–0.97) in the temporal validation cohort. For predicting the high axillary tumor burden, the AUC values of the developed radiomics nomogram are 0.82 (95% CI: 0.66–0.97) in the testing set and 0.77 (95% CI: 0.62–0.93) in the temporal validation cohort.DiscussionCESM images contain useful information for predicting NSLN metastasis and axillary tumor burden of breast cancer patients. Radiomics can inspire the potential of CESM images to identify lymph node metastasis and improve predictive performance.

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The impact of axillary ultrasound with biopsy in overtreatment of early breast cancer

Cited by 14 publications

References 26 publications

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

Validating the ACOSOG Z0011 Trial Result: A Population-Based Study Using the SEER Database

ACR Appropriateness Criteria® Imaging of the Axilla

Contrast-Enhanced Spectral Mammography-Based Prediction of Non-Sentinel Lymph Node Metastasis and Axillary Tumor Burden in Patients With Breast Cancer

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