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Ultrasound Int Open 2015; 01(01): E19-E24
DOI: 10.1055/s-0035-1555872
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Assessment of Ultrasound Features Predicting Axillary Nodal Metastasis in Breast Cancer: The Impact of Cortical Thickness

A. Stachs
1   Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
,
A. Tra-Ha Thi
1   Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
,
M. Dieterich
1   Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
,
J. Stubert
1   Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
,
S. Hartmann
1   Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
,
Ä. Glass
2   Institute for Biostatistics, University of Rostock, Rostock, Germany
,
T. Reimer
1   Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
,
B. Gerber
1   Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany
› Author Affiliations
Further Information

Publication History

received 11 May 2015

accepted 19 June 2015

Publication Date:
28 July 2015 (online)

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Abstract

Purpose: To evaluate the accuracy of axillary ultrasound (AUS) in detecting nodal metastasis in patients with early-stage breast cancer and to identify AUS features with high predictive power.

Materials and Methods: Prospective single-center preliminary study in 105 patients with a primary diagnosis of breast cancer and clinically negative axilla. AUS was performed using a 12 MHz linear-array transducer before ultrasound-guided needle biopsy. Nodal characteristics (shape, longitudinal-transverse [LT] axis ratio, margins, cortical thickness, hyperechoic hilum) were correlated with histopathological nodal status after SLNB or axillary lymph node dissection (ALND).

Results: Nodal metastases were present in 42/105 patients (40.0%). Univariate analyses showed that absence of hyperechoic hilum, round shape, LT axis ratio<2, sharp margins and cortical thickness>3 mm were associated with lymph node metastasis. Multivariate logistic regression analysis revealed cortical thickness > 3 mm as an independent predictive parameter for nodal involvement. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 66.7, 74.6, 63.6, 77.0% and 71.4% respectively when cortical thickness > 3 mm was applied as the criterion for AUS positivity. Axillary tumor volume was low in patients with pT1/2 tumors and negative AUS, since only 3.2% of patients had > 2 metastatic lymph nodes.

Conclusion: Cortical thickness>3 mm is a reliable predictor of nodal metastatic involvement. Negative AUS does not exclude lymph node metastases, but extensive axillary tumor volume is rare.

Key words

ultrasound - axilla - adenocarcinoma - breast - metastases
 

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