The impact of preoperative axillary ultrasonography in T1 breast tumours

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

doi:10.1007/s00330-015-3901-2

Cited by 19 publications

(6 citation statements)

References 52 publications

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“…In addition, the majority of our patients with positive needle biopsy or SLNB results had ALND; hence, the true axillary nodal status was accurately reflected. Our ultrasound sensitivity and specificity rate were also comparable with those reported in previous studies examining patients with early breast cancer [3171819].…”

Section: Discussionsupporting

confidence: 89%

Determining Whether High Nodal Burden in Early Breast Cancer Patients Can Be Predicted Preoperatively to Avoid Sentinel Lymph Node Biopsy

et al. 2019

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Purpose The Z0011 trial showed that axillary lymph node dissection (ALND) can be safely avoided in breast cancer patients with low nodal burden (LNB). ALND can be performed in patients with high nodal burden (HNB). We aimed to determine whether HNB in early breast cancer patients can be predicted preoperatively to avoid sentinel lymph node biopsy (SLNB). Methods Early invasive breast cancer patients (cT1-2cN0) were retrospectively reviewed. We excluded patients with neoadjuvant chemotherapy and incomplete data. The patients were divided into the following groups based on surgical histology: no positive (N0), LNB, and HNB, defined as 0, 1–2, and ≥ 3 metastatic lymph nodes (LNs), respectively. Of the patients with metastatic nodal disease, only those with ALND were included in the analysis. Clinical, radiological, and histological parameters were evaluated using logistic regression analysis as predictors of HNB versus LNB and N0 combined. Results Of the 1,298 included patients, 832 (64.1%), 286 (22.0%), and 180 (13.9%) had N0, LNB, and HNB, respectively. Univariate logistic regression analysis revealed that sonographic features of breast tumor size ( p < 0.0001), number of abnormal LNs ( p < 0.0001), cortical thickness ( p = 0.0002), effacement of the fatty hilum ( p < 0.0001), and needle biopsy being performed ( p < 0.0001) were indicators of HNB. Breast tumor grade ( p = 0.0001) and human epidermal growth factor receptor 2 status ( p = 0.0262) were also statistically significant. Among these significant features, multivariable stepwise logistic regression showed that the number of abnormal LNs is the sole independent predictor of HNB ( p < 0.0001, area under the curve = 0.774). The positive predictive value of HNB in patients with ≥ 4 abnormal LNs was 92.9%. Conclusion The detection of ≥ 4 abnormal LNs on ultrasound can help to identify HNB patients who require upfront ALND and thus avoid SLNB.

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Section: Discussionsupporting

confidence: 89%

Determining Whether High Nodal Burden in Early Breast Cancer Patients Can Be Predicted Preoperatively to Avoid Sentinel Lymph Node Biopsy

et al. 2019

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“…In additionally removed lymph nodes, metastases were found in 57.1% of the cases, while in the remaining cases, additionally removed nodes were node-negative. According to other studies in the literature, ALND followed by positive results for metastasis at SLNB showed the absence of metastasis of 38% to 67% in the remaining lymph nodes [29][30][31].…”

Section: Discussionmentioning

confidence: 59%

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Rukanskienė¹,

Veikutis²,

Jonaitienė³

et al. 2020

Medicina

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Background and objectives: With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50–75% to 15–30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients’ and tumor characteristics leading to false-negative results. Materials and Methods: A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. Results: Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, p < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), p = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, p < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, p < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients’ group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution.

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“…1 Although the surgical exploration of the axillary lymph nodes is required for definitive staging, axillary imaging using ultrasound and MRI has recently received renewed interest for preoperative staging in tandem with the evolving minimally invasive approaches in the investigation of the axilla. [2][3][4][5][6] Researchers have been trying to identify a subgroup of patients with breast cancer that can avoid axillary surgery in the ongoing SOUND (Sentinel Node vs Observation after Axillary Ultrasound) and INSEMA (Intergroup Sentinel Mamma) trials. [7][8][9][10] In addition, following the results of the ACOSOG (American College of Surgeons Oncology Group) Z1011 and AMAROS trials, axillary imaging is also currently expected to identify patients who can be managed appropriately with SLNB alone or ALND and with or without radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

Preoperative axillary nodal staging with ultrasound and magnetic resonance imaging: predictive values of quantitative and semantic features

Kim

Lee

et al. 2018

The British Journal of Radiology

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The impact of preoperative axillary ultrasonography in T1 breast tumours

Abstract: • AUS+FNA can predict axillary involvement, thus avoiding SNB. • Not all patients with axillary involvement need ALND. • Axillary tumour load determines axillary management. • AUS could classify patients according to axillary load.

Cited by 19 publications

References 52 publications

Determining Whether High Nodal Burden in Early Breast Cancer Patients Can Be Predicted Preoperatively to Avoid Sentinel Lymph Node Biopsy

Determining Whether High Nodal Burden in Early Breast Cancer Patients Can Be Predicted Preoperatively to Avoid Sentinel Lymph Node Biopsy

Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer

Preoperative axillary nodal staging with ultrasound and magnetic resonance imaging: predictive values of quantitative and semantic features

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