Role of ultrasonography to detect axillary node involvement in operable breast cancer

doi:10.1016/S0748-7983(96)90593-4

European Journal of Surgical Oncology (EJSO)

Volume 22, Issue 2, April 1996, Pages 140-143

https://doi.org/10.1016/S0748-7983(96)90593-4 Get rights and content

Prompted by the concern about unnecessary axillary dissections, we prospectively studied the accuracy of clinical examination (CE) and conventional ultrasonography (USG, 7.5 MHz), to diagnose pre-operatively metastatic axillary lymph nodes in 200 operable breast cancer patients. USG had higher specificity (90% vs 77%, P=0.025) and higher positive predictive value (ppv=90% vs 76%, P=0.02) than CE. Together, CE + USG had higher sensitivity (82% vs 58%, P=0.00005) and higher negative predictive value (npv = 76% vs 58%, P=0.008) than CE alone. In women <45 years, CE + USG had higher sensitivity (91% vs 76%, P=0.037) and npv (89% vs 67%, P=0.018) than in older women. The sensitivity and npv of CE + USG to detect >1 positive node were 97% (for both) in women <45 years compared to 81% and 79% in older women. The high sensitivity of CE + USG (82% for the whole group) is probably due to the higher proportion of young women (median age=45) in our population. It suggests that using CE + USG to avoid axillary dissection in some patients is feasible.

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In this retrospective study, we evaluated the axillary lymph node morphology of breast cancer patients with atopic dermatitis using ultrasound and compared it to previously reported axillary lymph node morphology in breast cancer patients. In previous studies by Bonnema et al. (1997) and Vaidya et al. (1996), the sensitivity was 69%–87% and the specificity was 56%–90% when axillary lymph nodes of ≥5 mm on the major axis were used as the criterion for diagnosing axillary lymph node metastases. In this study, when we used a major axis of ≥5 mm as the criterion for diagnosing metastases, the specificity was very low, at 12.7%, with many false-positive results.
This study assessed the diagnostic accuracy of ultrasound in detecting axillary lymph node metastases in women with breast cancer and atopic dermatitis. We retrospectively reviewed the records of 91 breast cancer patients with a history of atopic dermatitis and compared the dimensions of the lymph nodes on ultrasonographic images of women with and without lymph node metastases diagnosed using histology. Using a major-axis length of ≥5 mm, a short-axis length of ≥5 mm and a cortical thickness of ≥2.3 mm as the criteria for diagnosing axillary lymph node metastases, the specificity was 12.7%, 41.3% and 58.7%, respectively. The low specificity of the ultrasound criteria makes ultrasound unsuitable for diagnosing axillary lymph nodes metastases in breast cancer patients with atopic dermatitis.
Pre-operative ultrasonographic evaluation of axillary lymph nodes in breast cancer patients: For which group still of additional value and in which group cause for special attention?
2015, Ultrasound in Medicine and Biology
A non-invasive and widely available method for pre-operative evaluation of the axilla is axillary ultrasonography (US). The purpose of this study was to evaluate the diagnostic accuracy of axillary US and fine-needle aspiration cytology in a large cohort of breast cancer patients. The sensitivity and specificity of US and fine-needle aspiration cytology in our cohort of 1124 patients were 42.2% and 97.1%, respectively. As the number of axillary nodes increased, sensitivity increased. The percentage of false-negative US results was 18.9%; patients in this subgroup were significantly younger, had larger tumors, more often had lymph vascular invasion and were more likely to have estrogen receptor-positive tumors. Ultrasonography in combination with fine-needle aspiration cytology is useful in the pre-operative workup of breast cancer patients, especially patients with three or more nodal metastases. Special attention should be paid to younger women with larger tumors in whom a larger percentage of false-negative results are obtained.
Sensitivity, specificity and accuracy of ultrasound in diagnosis of breast cancer metastasis to the axillary lymph nodes in Chinese patients
2015, Ultrasound in Medicine and Biology
Citation Excerpt :
Among these, axillary lymph node status is one of the most important prognostic factors in breast cancer. Thus, pre-operative axillary ultrasound is crucial to staging and management of breast cancer in many institutions (Gentilini and Veronesi 2012; Vaidya et al. 1996). For example, accurate evaluation of axillary lymph node status could avoid an unnecessary sentinel lymph node biopsy (SLNB) or even the maximally invasive radical resection (Moorman et al. 2014).
The use of ultrasound in the diagnosis of axillary lymph node metastases from breast cancer in a Chinese population was investigated. Data for 1,049 with breast cancer were retrospectively collected. All patients had undergone pre-operative axillary ultrasound and then axillary lymph node dissection. The sensitivity, specificity and accuracy of axillary ultrasound in this cohort were 69.4%, 81.8% and 77.0%, respectively. The overall false-negative rate of ultrasound images was 30.6% (123/402). False-negative ultrasound rates for pathologic N1, N2 and N3 patients were 46.2%, 21.8% and 9.3%, respectively. In patients with stage T1 disease and fewer than three metastatic lymph nodes, the false-negative ultrasound rate was 52.2% (47/90). Moreover, breast cancer patients with a false-negative axillary ultrasound were more likely to have a large tumor (p < 0.001) and high tumor grade (p = 0.009). However, there were no statistically significant differences between accuracy of axillary ultrasound and age of patients or experiences of ultrasound practitioners. In conclusion, the sensitivity, specificity and accuracy of ultrasound in the diagnosis of breast cancer metastasis to the axillary lymph nodes in Chinese patients were assessed. These data could help us to carefully use axillary ultrasound to diagnose and predict breast cancer axillary lymph node metastasis.
Utility of preoperative ultrasound for predicting pN2 or higher stage axillary lymph node involvement in patients with newly diagnosed breast cancer
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The purpose of this study was to investigate false-negative results of preoperative axillary ultrasound (US) and to evaluate clinicopathologic factors related to false-negative results in patients with invasive breast cancer. Four-hundred eighty-two patients with 483 invasive breast cancers who had no suspicious findings on preoperative axillary US were included in this study. All patients underwent sentinel lymph node biopsy (SLNB) or axillary lymph node dissection. False-negative and true-negative results were compared in terms of age, body mass index (BMI), T-stage, pathologic N-stage and final diagnosis of breast cancer. Statistical analyses were performed using the chi-square or Fisher's exact tests. Of the 483 axillae with negative results on axillary US, 93 axillae of 93 patients showed false-negative results and the negative predictive value of axillary US was 80.8% (390/483). Seventy-five axillae (15.5%, 75/483) had N1 and 18 axillae (3.7%, 18/483) had N2 or N3 disease. Eighteen false-negative results with N2/N3 disease showed a significantly higher T stage (T2/T3) than those with N1 disease. As the T-stage increased, false-negative results were found more often on preoperative axillary US (p < 0.05). Age, BMI and final diagnosis of primary breast cancer were not associated with false-negative results on preoperative axillary US. Preoperative axillary US alone is insufficiently specific to obviate the need for SLNB because of the substantial number of false-negative results in patients with invasive breast cancer, although preoperative axillary US alone may exclude most cases of N2 and N3 disease.
Predictors of sentinel lymph node metastasis in Chinese women with clinical T1-T2 N0 breast cancer and a normal axillary ultrasound
2022, Acta Radiologica

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Original articleRole of ultrasonography to detect axillary node involvement in operable breast cancer

Clin Radiol

Axillary lymph node dissection for T1a breast carcinoma

Cancer

The need to re-examine axillary lymph node dissection in invasive breast cancer

Cancer

Accuracy of ultrasound and clinical examination in the diagnosis of axillary lymph node metastases in breast cancer

Eur J Surg Oncol

Ultrasonographic detection of metastatic axillary lymph nodes in breast cancer

Ann Chir Gynaecol

Original article
Role of ultrasonography to detect axillary node involvement in operable breast cancer