Axillary tumour burden in women with one abnormal node on ultrasound compared to women with multiple abnormal nodes

Puri, Shama; Sharma, Nisha; Newcombe, R. G.; Kaushik, Monika; Al-Attar, M; Pascaline, Sana; Hajaj, Mohamad; Wallis, Matthew; Elsberger, Beatrix; Goyal, Amit

doi:10.1016/j.crad.2017.12.014

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…For patients with needle biopsy proven positive nodes at presentation, axillary lymph node dissection (ALND) is generally indicated if they undergo primary surgery. However, a subgroup with low volume nodal disease based on number of abnormal nodes on axillary ultrasound and tumour size [1] can be offered sentinel node biopsy rather than ALND. Patients found to have less than 3 involved nodes on SNB may be spared ALND [2;3].…”

Section: Introductionmentioning

confidence: 99%

A multicentre prospective feasibility study of carbon dye tattooing of biopsied axillary node and surgical localisation in breast cancer patients

Goyal

Puri

Marshall

et al. 2020

Breast Cancer Res Treat

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Section: Introductionmentioning

confidence: 99%

A multicentre prospective feasibility study of carbon dye tattooing of biopsied axillary node and surgical localisation in breast cancer patients

Goyal

Puri

Marshall

et al. 2020

Breast Cancer Res Treat

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“…Around 50% of patients with axillary node metastases from breast cancer have these diagnosed preoperatively [1]. It is known that pre-operative node positive patients are found to possess higher nodal burden of disease compared to patients diagnosed surgically on sentinel lymph node biopsy (SLNB) [2,3]. However, a significant number of patients with a pre-operative diagnosis of axillary metastases also have a low nodal burden [4].…”

Section: Introductionmentioning

confidence: 99%

Mode of presentation and skin thickening on ultrasound may predict nodal burden in breast cancer patients with a positive axillary core biopsy

Choong

Evans

Purdie

et al. 2020

The British Journal of Radiology

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Objective: A number of pre-operative factors predicting nodal burden in females with breast cancer have recently been identified. The aim of this study is to assess if these factors independently influence nodal burden in females with a positive axillary core biopsy. Methods: All node positive patients detected on axillary core biopsy were identified in our cancer audit database. Mode of presentation, age, core tumour grade, core tumour type, ER and HER2 status were evaluated. Tumours were assessed for ultrasound size, distance of tumour-to-skin, presence of invasion of skin and diffuse skin thickening. Axillary lymph nodes were assessed for cortical thickness and presence of ultrasound replaced nodes. Statistical significance was ascertained using univariate logistic regression. A predictive model was produced following a multiple logistic regression model incorporating cross-validation and assessed using receiving operating characteristic curve. Results: 115 patients’ data were analysed. Patients referred because of symptoms (70% vs 38%, p = 0.005), and those with ultrasound skin thickening (87% vs 59%, p = 0.055) have higher nodal burden than those referred from screening or without skin thickening. These factors were significant after multivariate analysis. The final predictive model included mode of presentation, ultrasound tumour size, cortical thickness and presence of ultrasound skin thickening. The area under curve is 0.77. Conclusion: We have shown that mode of presentation and ultrasound skin thickening are independent predictors of high nodal burden at surgery. A model has been developed to predict nodal burden pre-operatively, which may lead to avoidance of axillary node clearance in patients with lower nodal burden. Advances in knowledge: Method of presentation and skin involvement/proximity to skin by the primary tumour are known to influence outcome and nodal involvement respectively but have not been studied with regard to nodal burden. We have shown that mode of presentation and skin thickening at ultrasound are independent predictors of high nodal burden at surgery.

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“…The number of suspicious LNs detected was also related to outcome when using LN >2 as the cutoff in the prediction of high burden (38). In this paper, one LN was used as the cutoff for prediction because one abnormal LN on AUS can be predictive of a low burden of LNs (N 1-2 ), as demonstrated by Puri et al (39) Other USdependent characteristics, such as the maximum LN axis and the effacement of the lymphatic hilum, are closely related to a negative LN status (40). The lymphatic hilum is an entrance for lymphatic vessels and nerves.…”

Section: Discussionmentioning

confidence: 85%

Establishment and Validation of The Axillary Lymph Node Burden Using Cone-Beam Computerized Tomography and Ultrasound-Based Prediction Models in T1-2 Breast Cancer Patients

Shen

Cai

et al. 2021

Preprint

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Background: This study aimed to develop and validate models to preoperatively predict the risk of the lymph node (LN) burden based on the Z0011 clinical trial to assist breast cancer surgical decision-making.Methods: Data on 1394 consecutive patients who presented at Sun Yat-sen University Cancer Center for Cone-beam breast computerized tomography (CBBCT) examinations between April 3, 2019, and July 17, 2020, were retrospectively collected. 387 patients who met the inclusion criteria were included and randomly divided into training and validation cohorts. Clinical-pathological information of all patients was recorded, and images were reinterpreted in this study. A bidirectional stepwise method followed by multi-variable analysis was used to incorporate preoperative features and build optimal model sets with the training cohort for prediction of N0 versus N+ and N＜3 versus N≥3.Results: The ROC curves of two models were generated with the training cohort, and their calibration abilities were estimated using 1000 bootstrap resamples. The bias-corrected C-index of the models were 0.779 (95% CI, 0.752–0.793) in model one and 0.809 (95% CI, 0.794–0.833) in model two for the training cohort. Decision curves and clinical impact curves were plotted to evaluate prediction performance for further clinical application. Delong’s test showed comparable performance of both cohorts.Conclusions: Our models were developed as reliable and noninvasive tools for the preoperative prediction of nodal status, and we hope that they can serve as useful tools for the early planning of treatment strategies for breast cancer patients.

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Axillary tumour burden in women with one abnormal node on ultrasound compared to women with multiple abnormal nodes

Abstract: Among women with needle-biopsy-proven positive nodes, around three in four women (78%) with an invasive tumour ≤2 cm and one abnormal node on AUS have two or fewer positive nodes at ALND. These women are overtreated by upfront ALND and can be offered sentinel node biopsy (SNB).

Cited by 12 publications

References 17 publications

A multicentre prospective feasibility study of carbon dye tattooing of biopsied axillary node and surgical localisation in breast cancer patients

A multicentre prospective feasibility study of carbon dye tattooing of biopsied axillary node and surgical localisation in breast cancer patients

Mode of presentation and skin thickening on ultrasound may predict nodal burden in breast cancer patients with a positive axillary core biopsy

Establishment and Validation of The Axillary Lymph Node Burden Using Cone-Beam Computerized Tomography and Ultrasound-Based Prediction Models in T1-2 Breast Cancer Patients

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