Optimal Selection of Imaging Examination for Lymph Node Detection of Breast Cancer With Different Molecular Subtypes

Abstract

ObjectiveAxillary lymph node management is an important part of breast cancer surgery and the accuracy of preoperative imaging evaluation can provide adequate information to guide operation. Different molecular subtypes of breast cancer have distinct imaging characteristics. This article was aimed to evaluate the predictive ability of imaging methods in accessing the status of axillary lymph node in different molecular subtypes.MethodsA total of 2,340 patients diagnosed with primary invasive breast cancer after breast surgery from 2013 to 2018 in Jiangsu Breast Disease Center, the First Affiliated Hospital with Nanjing Medical University were included in the study. We collected lymph node assessment results from mammography, ultrasounds, and MRIs, performed receiver operating characteristic (ROC) analysis, and calculated the sensitivity and specificity of each test. The C-statistic among different imaging models were compared in different molecular subtypes to access the predictive abilities of these imaging models in evaluating the lymph node metastasis.ResultsIn Her-2 + patients, the C-statistic of ultrasound was better than that of MRI (0.6883 vs. 0.5935, p=0.0003). The combination of ultrasound and MRI did not raise the predictability compared to ultrasound alone (p=0.492). In ER/PR+HER2- patients, the C-statistic of ultrasound was similar with that of MRI (0.7489 vs. 0.7650, p=0.5619). Ultrasound+MRI raised the prediction accuracy compared to ultrasound alone (p=0.0001). In ER/PR-HER2- patients, the C-statistics of ultrasound was similar with MRI (0.7432 vs. 0.7194, p=0.5579). Combining ultrasound and MRI showed no improvement in the prediction accuracy compared to ultrasound alone (p=0.0532).ConclusionFrom a clinical perspective, for Her-2+ patients, ultrasound was the most recommended examination to assess the status of axillary lymph node metastasis. For ER/PR+HER2- patients, we suggested that the lymph node should be evaluated by ultrasound plus MRI. For ER/PR-Her2- patients, ultrasound or MRI were both optional examinations in lymph node assessment. Furthermore, more new technologies should be explored, especially for Her2+ patients, to further raise the prediction accuracy of lymph node assessment.

Intermammary breast cancer: A rare case of cancer with origin of breast cells in an unusual location

“…Zheng et al study showed that ER/PR+ HER2− patients using both the ultrasonography method and magnetic resonance imaging (MRI) is more valuable in diagnosing the disease. 26 , 27 …”

“…Zheng et al study showed that ER/PR+ HER2− patients using both the ultrasonography method and magnetic resonance imaging (MRI) is more valuable in diagnosing the disease. 26,27 MRI is another important diagnostic tool that can be used for monitoring the response to the treatment, high-risk patients, and detection of metastasis 7,26 But MRI is used in complex cases because of the cost problem in our country.…”

Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial

“…This suggests that the SN technique is even less reliable in patients with axillary lymph node involvement and a more proliferative breast cancer, which is therefore more aggressive. Future trials should analyze all the techniques available to quantify axillary tumor load considering the histopathological, immunohistochemical and molecular characteristics of the tumors, given that it has been proven that these features influence the axillary tumor load (24,25) and the accuracy of diagnostic tests (26,27) An obvious limitation of this initial phase of the MUTAS trial is the very small number of patients analyzed that did not reach the predefined estimated sample size. The reason for the low recruitment was the outbreak of the COVID 2019 (COVID-19) pandemic a few months after the start of the study, 2.5 years ago.…”

Contrast-enhanced Ultrasound Using Intradermal Microbubble Sulfur Hexafluoride for Identification of Sentinel Lymph Nodes During Breast Cancer Surgery: A Clinical Trial

“…However, as mentioned before, LN disease will be underestimated in up to 30% patients with conventional US, with detrimental effects on clinical care and clinical decision-making. It is safe to assume that even if a large proportion of these patients meet the Z0011 criteria (21,43), a significative proportion with positive LNs may be misclassified as having EBC, missing the chance for neoadjuvant medical therapy prior to surgery (44,45).…”