Diagnostic Accuracy of Axillary Ultrasonography Compared with Intra-operative Pathological Findings in Patients with Breast Cancer

Abstract

Objective: Breast cancer is the most common cancer and leading cause of mortality in women worldwide. Diagnosis of axillary lymph node involvement, frequently by axillary ultrasonography (AUS), is an important step in patients with primary breast cancer, while the gold standard pathological examination is only applicable during surgery. Thus, we aimed to evaluate the predictive value of AUS in detection of lymph node involvement. Methods: A total of 56 patients with primary breast cancer, who were candidate of mastectomy were included in this study. A single radiologist performed pre-operative axillary sonography for all the patients and reported the results in a checklist. The results were then compared with intra-operative pathological results of lymph node dissection to evaluate the sensitivity, specificity, positive and negative predictive values of AUS in detection of the disease. Result: The results showed that pre-operative AUS had a sensitivity of 63.3%, specificity of 84.6%, positive predictive value of 82.6%, and negative predictive value of 66.6%. Correlation between axillary lymph node characteristics revealed that the absence of fatty hilum, cortical thickness, and loss of ovality of the lymph nodes were the most specific factors in detection of lymph nodes' involvement. Conclusion: AUS has a low sensitivity and cannot determine the presence of micro-metastases and suspicious lymph nodes accurately in early stages of the disease, and it seems that defining new parameters may help for increasing the sensitivity and specificity of the axillary lymph node sonography. Apparently, pathological examination remains the gold standard diagnostic method.

Evaluation of Different Imaging Modalities for Axillary Lymph Node Staging in Breast Cancer Patients to Provide A Personalized and Optimized Therapy Algorithm

“…Our results are within the expected range. It is however noticeable that sensitivity for sonography is reported to vary from 15.00 to 85.00% [5,6,37,38]. Elastography may improve sensitivity in this context [39,40].…”

“…Sonography as the standard technique for lymph node evaluation varies from 15.00 to 85.00% in terms of sensitivity. The speci city however is stated to be about 90.00 to 95.00% depending on the literature [6,37,38]. We therefore focused on the sensitivity of different medical imaging procedures: sonography, mammography, MRI and CT and aimed to analyze which technique could improve sensitivity in terms of the detection of tumor-in ltrated lymph nodes.…”

Radioterapia intraoperatoria en cáncer de mama precoz: análisis observacional frente a radioterapia externa

“…Es una cifra ligeramente inferior al 26% de esta serie, en la que encontramos la afectació n axilar como principal causa de radiació n adyuvante. La ecografía axilar en EBC tiene una baja sensibilidad para poder detectar metá stasis ganglionares de forma preoperatoria 24 . En estos casos el tratamiento puede complementarse con WBRT, actuando la IORT como una sobreimpresió n del lecho.…”

The NILS Study Protocol: A Retrospective Validation Study of an Artificial Neural Network Based Preoperative Decision-Making Tool for Noninvasive Lymph Node Staging in Women with Primary Breast Cancer (ISRCTN14341750)

“…Axillary ultrasound, the most used imaging modality for nodal assessment, is an unreliable staging modality for BC patients with a low nodal metastatic burden; its negative predictive value (60% to 90%) is not reassuring [5][6][7][8][9]. Different rates of sensitivity and specificity of axillary ultrasound are reported in the literature, ranging from 26% to 94% and from 53% to 98%, respectively [7][8][9][10][11].…”