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Erschienen in: Breast Cancer 1/2012

01.01.2012 | Original Article

Prospective ultrasonographic prediction of sentinel lymph node metastasis by real-time virtual sonography constructed with three-dimensional computed tomography–lymphography in breast cancer patients

verfasst von: Shigeru Yamamoto, Noriko Maeda, Michiko Tamesa, Yukiko Nagashima, Kiyoshi Yoshimura, Masaaki Oka

Erschienen in: Breast Cancer | Ausgabe 1/2012

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Abstract

Background

Real-time virtual sonography (RVS) systems display virtual multiplanar reconstruction (MPR) images obtained from three-dimensional (3D) computed tomography (CT)–lymphography (LG), significantly improving preoperative detection of sentinel lymph nodes (SLNs). The purpose of this study was to prospectively evaluate SLN metastasis using an RVS system.

Methods

We identified SLNs in 73 clinically node-negative breast cancer patients using an RVS system to display in real time a virtual MPR obtained from CT volume data corresponding to the same cross-sectional image from ultrasonography (US). CT volume data were obtained using our original 3DCT–LG, which accurately detects SLNs in breast cancer. We then prospectively attempted to predict metastasis to SLNs. SLN metastases were assessed by measuring the cortex thickness in the presence of a visible hilum. We defined suspected SLN metastases as SLNs with a cortex thickness of at least 2.5 mm on the basis of our preliminary data. All patients underwent SLN biopsy and SLN metastases were examined pathologically with serial 2.0-mm-thick multiple slices.

Results

Suspected SLN metastases were identified in 24 of 73 patients, and 13 of these 24 patients were pathologically positive. The remaining 49 patients displayed no suspected SLNs, and 46 of these 49 were pathologically negative. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of measuring cortical thickness for predicting metastatic involvement of SLNs were 81, 81, 54, 94, and 81%, respectively.

Conclusion

If cortical thickness of the SLN is less than 2.5 mm, SLN metastasis is unlikely to be present. If cortical thickness of the SLN is at least 2.5 mm, preoperative fine-needle aspiration cytology may be recommended to verify the possibility of SLN metastasis.
Literatur
1.
Zurück zum Zitat Naik AM, Fey J, Gemignani M, Heerdt A, Montgomery L, Petrek J, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240:462–8. PubMedCrossRef Naik AM, Fey J, Gemignani M, Heerdt A, Montgomery L, Petrek J, et al. The risk of axillary relapse after sentinel lymph node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg. 2004;240:462–8. PubMedCrossRef
2.
Zurück zum Zitat Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997;349:1864–7. PubMedCrossRef Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997;349:1864–7. PubMedCrossRef
3.
Zurück zum Zitat Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33. PubMedCrossRef Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33. PubMedCrossRef
4.
Zurück zum Zitat Barranger E, Dubernard G, Fleurence J, Antoine M, Darai E, Uzan S. Subjective morbidity and quality of life after sentinel node biopsy and axillary lymph node dissection for breast cancer. J Surg Oncol. 2005;92:17–22. PubMedCrossRef Barranger E, Dubernard G, Fleurence J, Antoine M, Darai E, Uzan S. Subjective morbidity and quality of life after sentinel node biopsy and axillary lymph node dissection for breast cancer. J Surg Oncol. 2005;92:17–22. PubMedCrossRef
5.
Zurück zum Zitat Suga K, Ogasawara N, Yuan Y, Okada M, Matsunaga N, Tangoku A. Visualization of breast lymphatic pathways with an indirect CT lymphography using a nonionic monometric contrast medium iopamidol: preliminary results. Invest Radiol. 2003;38:73–84. PubMedCrossRef Suga K, Ogasawara N, Yuan Y, Okada M, Matsunaga N, Tangoku A. Visualization of breast lymphatic pathways with an indirect CT lymphography using a nonionic monometric contrast medium iopamidol: preliminary results. Invest Radiol. 2003;38:73–84. PubMedCrossRef
6.
Zurück zum Zitat Tangoku A, Yamamoto S, Suga K, Ueda K, Nagashima Y, Hida M, et al. Sentinel lymph node biopsy using computed tomography–lymphography in patients with breast cancer. Surgery. 2004;135:258–65. PubMedCrossRef Tangoku A, Yamamoto S, Suga K, Ueda K, Nagashima Y, Hida M, et al. Sentinel lymph node biopsy using computed tomography–lymphography in patients with breast cancer. Surgery. 2004;135:258–65. PubMedCrossRef
7.
Zurück zum Zitat Suga K, Yamamoto S, Tangoku A, Oka M, Kawakami Y, Matsunaga N. Breast sentinel lymph node navigation with three-dimensional interstitial multidetector-row computed tomographic lymphography. Invest Radiol. 2005;40:336–42. PubMedCrossRef Suga K, Yamamoto S, Tangoku A, Oka M, Kawakami Y, Matsunaga N. Breast sentinel lymph node navigation with three-dimensional interstitial multidetector-row computed tomographic lymphography. Invest Radiol. 2005;40:336–42. PubMedCrossRef
8.
Zurück zum Zitat Iwasaki T, Mikami E, Shimosegawa T, Arai O, Mitake T. Real-time virtual sonography: a novel navigation tool in percutaneous radiofrequency ablation of hepatocellular carcinomas. In: Radiological Society of North America scientific assembly and annual meeting program. Oak Brook: Radiological Society of North America; 2004. p. 392 (abstr). Iwasaki T, Mikami E, Shimosegawa T, Arai O, Mitake T. Real-time virtual sonography: a novel navigation tool in percutaneous radiofrequency ablation of hepatocellular carcinomas. In: Radiological Society of North America scientific assembly and annual meeting program. Oak Brook: Radiological Society of North America; 2004. p. 392 (abstr).
9.
Zurück zum Zitat Yamamoto S, Maeda N, Tamesa M, Nagashima Y, Suga K, Oka M, et al. Sentinel lymph node detection in breast cancer patients by real-time virtual sonography constructed with three-dimensional computed tomography-lymphography. Breast J. 2010;16:4–8. PubMedCrossRef Yamamoto S, Maeda N, Tamesa M, Nagashima Y, Suga K, Oka M, et al. Sentinel lymph node detection in breast cancer patients by real-time virtual sonography constructed with three-dimensional computed tomography-lymphography. Breast J. 2010;16:4–8. PubMedCrossRef
10.
Zurück zum Zitat Nakano S, Yoshida M, Fujii K, Yorozuya K, Mouri Y, Kousaka J, et al. Fusion of MRI and sonography image for breast cancer evaluation using real-time virtual sonography with magnetic navigation: first experience. Jpn J Clin Oncol. 2009;39:552–9. PubMedCrossRef Nakano S, Yoshida M, Fujii K, Yorozuya K, Mouri Y, Kousaka J, et al. Fusion of MRI and sonography image for breast cancer evaluation using real-time virtual sonography with magnetic navigation: first experience. Jpn J Clin Oncol. 2009;39:552–9. PubMedCrossRef
11.
12.
Zurück zum Zitat Alvarez S, Añorbe E, Alcorta P, López F, Alonso I, Cortés J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol. 2006;186:1342–8. PubMedCrossRef Alvarez S, Añorbe E, Alcorta P, López F, Alonso I, Cortés J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol. 2006;186:1342–8. PubMedCrossRef
13.
Zurück zum Zitat Moore A, Hester M, Nam MW, Brill YM, McGrath P, Wright H, et al. Distinct lymph nodal sonographic characteristics in breast cancer patients at high risk for axillary metastases correlate with the final axillary stage. Br J Radiol. 2008;81:630–6. PubMedCrossRef Moore A, Hester M, Nam MW, Brill YM, McGrath P, Wright H, et al. Distinct lymph nodal sonographic characteristics in breast cancer patients at high risk for axillary metastases correlate with the final axillary stage. Br J Radiol. 2008;81:630–6. PubMedCrossRef
14.
Zurück zum Zitat Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD, et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol. 2008;191:646–52. PubMedCrossRef Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD, et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol. 2008;191:646–52. PubMedCrossRef
15.
Zurück zum Zitat Susini T, Nori J, Olivieri S, Molino C, Marini G, Bianchi S, et al. Predicting the status of axillary lymph nodes in breast cancer: a multiparameter approach including axillary ultrasound scanning. Breast. 2009;18:103–8. PubMedCrossRef Susini T, Nori J, Olivieri S, Molino C, Marini G, Bianchi S, et al. Predicting the status of axillary lymph nodes in breast cancer: a multiparameter approach including axillary ultrasound scanning. Breast. 2009;18:103–8. PubMedCrossRef
16.
Zurück zum Zitat Choi YJ, Ko EY, Han BK, Shin JH, Kang SS, Hahn SY. High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast. 2009;18:119–22. PubMedCrossRef Choi YJ, Ko EY, Han BK, Shin JH, Kang SS, Hahn SY. High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast. 2009;18:119–22. PubMedCrossRef
17.
Zurück zum Zitat Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM. Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy—clinical experience in 100 patients. Radiology. 2009;250:41–9. PubMedCrossRef Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM. Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy—clinical experience in 100 patients. Radiology. 2009;250:41–9. PubMedCrossRef
18.
Zurück zum Zitat Deurloo EE, Tanis PJ, Gilhuijs KG, Muller SH, Kröger R, Peterse JL, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer. 2003;39:1068–73. PubMedCrossRef Deurloo EE, Tanis PJ, Gilhuijs KG, Muller SH, Kröger R, Peterse JL, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer. 2003;39:1068–73. PubMedCrossRef
19.
Zurück zum Zitat Cho N, Moon WK, Han W, Park IA, Cho J, Noh DY, et al. Preoperative sonographic classification of axillary lymph nodes in patients with breast cancer: node-to-node correlation with surgical histology and sentinel node biopsy results. Am J Roentgenol. 2009;193:1731–7. CrossRef Cho N, Moon WK, Han W, Park IA, Cho J, Noh DY, et al. Preoperative sonographic classification of axillary lymph nodes in patients with breast cancer: node-to-node correlation with surgical histology and sentinel node biopsy results. Am J Roentgenol. 2009;193:1731–7. CrossRef
20.
Zurück zum Zitat Bonnema J, van Geel AN, van Ooijen B, Mali SP, Tjiam SL, Henzen-Logmans SC, et al. Ultrasound-guided aspiration biopsy for detection of non palpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg. 1997;21:270–4. PubMedCrossRef Bonnema J, van Geel AN, van Ooijen B, Mali SP, Tjiam SL, Henzen-Logmans SC, et al. Ultrasound-guided aspiration biopsy for detection of non palpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg. 1997;21:270–4. PubMedCrossRef
21.
Zurück zum Zitat Krishnamurthy S, Sneige N, Bedi DG, Edieken BS, Fornage BD, Kuerer HM, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. 2002;95:982–8. PubMedCrossRef Krishnamurthy S, Sneige N, Bedi DG, Edieken BS, Fornage BD, Kuerer HM, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. 2002;95:982–8. PubMedCrossRef
22.
Zurück zum Zitat Kuenen-Boumeester V, Menke-Pluymers M, de Kanter AY, Obdeijn IM, Urich D, Van Der Kwast TH. Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure. Eur J Cancer. 2003;39:170–4. PubMedCrossRef Kuenen-Boumeester V, Menke-Pluymers M, de Kanter AY, Obdeijn IM, Urich D, Van Der Kwast TH. Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure. Eur J Cancer. 2003;39:170–4. PubMedCrossRef
23.
Zurück zum Zitat Alkuwari E, Auger M. Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic–histologic correlation. Cancer. 2008;114:89–93. PubMedCrossRef Alkuwari E, Auger M. Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic–histologic correlation. Cancer. 2008;114:89–93. PubMedCrossRef
24.
Zurück zum Zitat Jain A, Haisfield-Wolfe ME, Lange J, Ahuja N, Khouri N, Tsangaris T, et al. The role of ultrasound-guided fine-needle aspiration of axillary nodes in the staging of breast cancer. Ann Surg Oncol. 2008;15:462–71. PubMedCrossRef Jain A, Haisfield-Wolfe ME, Lange J, Ahuja N, Khouri N, Tsangaris T, et al. The role of ultrasound-guided fine-needle aspiration of axillary nodes in the staging of breast cancer. Ann Surg Oncol. 2008;15:462–71. PubMedCrossRef
25.
Zurück zum Zitat Koelliker SL, Chung MA, Mainiero MB, Steinhoff MM, Cady B. Axillary lymph nodes: US-guided fine-needle aspiration for initial staging of breast cancer—correlation with primary tumor size. Radiology. 2008;246:81–9. PubMedCrossRef Koelliker SL, Chung MA, Mainiero MB, Steinhoff MM, Cady B. Axillary lymph nodes: US-guided fine-needle aspiration for initial staging of breast cancer—correlation with primary tumor size. Radiology. 2008;246:81–9. PubMedCrossRef
26.
Zurück zum Zitat Baruah BP, Goyal A, Young P, Douglas-Jones AG, Mansel RE. Axillary node staging by ultrasonography and fine-needle aspiration cytology in patients with breast cancer. Br J Surg. 2010;97:680–3. PubMedCrossRef Baruah BP, Goyal A, Young P, Douglas-Jones AG, Mansel RE. Axillary node staging by ultrasonography and fine-needle aspiration cytology in patients with breast cancer. Br J Surg. 2010;97:680–3. PubMedCrossRef
Metadaten
Titel
Prospective ultrasonographic prediction of sentinel lymph node metastasis by real-time virtual sonography constructed with three-dimensional computed tomography–lymphography in breast cancer patients
verfasst von
Shigeru Yamamoto
Noriko Maeda
Michiko Tamesa
Yukiko Nagashima
Kiyoshi Yoshimura
Masaaki Oka
Publikationsdatum
01.01.2012
Verlag
Springer Japan
Erschienen in
Breast Cancer / Ausgabe 1/2012
Print ISSN: 1340-6868
Elektronische ISSN: 1880-4233
DOI
https://doi.org/10.1007/s12282-011-0275-4

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