Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention?

Moorman, A. M.; Bourez, R. L. J. H.; Leeuw, Daniëlle M. de; Kouwenhoven, E.A.

doi:10.1016/j.ultrasmedbio.2015.06.013

Cited by 24 publications

(13 citation statements)

References 37 publications

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“…Compared with HER-2 and triple negative breast cancer patients, the high false negative rate of luminal A or luminal B might be due to the positive hormone receptor. In addition, our data indicated that false negative patients were more likely to occur in younger than 50 years old, Ki-67 high expression (> 20%), larger primary tumor size (> 2 cm) and higher histological grade, which was consistent with the results of Yan' na Zhang and other studies [27]. Therefore, in the high-risk subgroups that can lead to high false negative rate, we should carefully consider the results of ultrasound, and combine other examination methods, such as various kinds of tumor puncture biopsy, to improve the accuracy of preoperative diagnosis [28][29][30][31].…”

Section: Discussionsupporting

confidence: 92%

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

Liu

Wang

et al. 2020

Preprint

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Background: Axillary lymph node dissection can be avoided in early stage breast cancer patients with negative sentinel lymph node biopsy. However, the possibility of avoiding axillary surgery in patients without axillary lymph node metastasis (ALNM) by preoperative imaging is still under exploration. Thus, the objectives of this study were to investigate the high-risk factors of false negative of ALNM diagnosed by preoperative ultrasound (US) and to find out who could be avoided axillary surgery in the US negative ALNM patients.Methods: This study retrospectively analyzed 3,361 patients with primary early breast cancer diagnosed in the Breast Center of the Fourth Hospital of Hebei Medical University from January 2010 to December 2012. All patients had undergone routine preoperative US and then axillary lymph node dissected. This study investigated the clinicopathological features of axillary lymph node (ALN) negative patients diagnosed by preoperative US and its correlation with prognosis. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 2,357 patients. Results: The sensitivity, specificity and accuracy of axillary US in this cohort were 66.24%, 76.62% and 73.87%. The proportion of patients in the false negative group was higher than that in true negative in the group of age < 50 years old (P = 0.002), tumor size > 2cm (P = 0.008), estrogen receptor (ER) positive (P = 0.005), progesterone receptor (PR) high expression (P = 0.007), nuclear-associated antigen Ki-67 (Ki-67) >20% (P = 0.030), visible vascular tumor thrombus (P < 0.001) and histological grade>2 (P < 0.001). Prognostic analysis of false negative and true negative ultrasonographic diagnosis of ALN metastasis: when ALNM was not found by preoperative ultrasound, there was no significant difference in patients with ALNM≤3 compared with patients without lymph node metastasis in patients of age ≥ 50 years old, tumor size ≤ 2cm, Ki-67 ≤ 20%, or histological grade ≤ 2. Conclusion: The surgery of ALN may be avoided for the preoperative US diagnosed ALNs negative in early breast cancer patients who had advanced age, small tumor size, low expression of Ki-67 and low histological grade.

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Section: Discussionsupporting

confidence: 92%

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

Liu

Wang

et al. 2020

Preprint

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“…Similarly, no difference was determined in respect of the biological subtypes of the primary tumor. Johnson et al [24] and Moorman et al [25] demonstrated that tumors which express ER or PR had a higher possibility to have false-negative AUS. The association between false-negative AUS result and ER expression is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Histopathological and Tumor Characteristics Associated with False Negative Axillary Ultrasonography Results in Breast Cancer

et al. 2019

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tion alone is not sufficient. Preoperative axillary ultrasonography (AUS) with the sensitivity of 50-70% and specificity of 87-95% is an indispensable part of staging [1]. When AUS is positive, sentinel lymph node biopsy (SLNB), which is an invasive procedure and requires additional costs, is passed and axillary lymph node dissection (ALND) can be applied [2][3][4]. Thus. time and expense can be saved. However, as the false-negative rates of AUS (21%-48%) are not optimal, the demand for axillary surgery remains even if AUS is negative [5][6][7][8]. Therefore, in many centers AUS is combined with fine needle aspiration biopsy (FNAB) and the accuracy is increased in the determination of metastatic axillary lymph nodes [9][10][11]. However, a negative FNAB still does not remove the necessity for SLNB. All this classic information started to change with the recent Z0011 Trial Abstract Aims: As the false-negative rates of axillary ultrasonography (AUS) (21%-48%) are not optimal, the demand for axillary surgery remains even if AUS is negative. The aim of this study is to determine the histopathological and tumor characteristics associated with false-negative AUS results. Materials and methods: Patients with normal AUS were divided into two groups as true-negative and false-negative according to the histopathology results of axillary lymph nodes. Two groups were compared in terms of age, histological grade of the primary tumor, histological size of the primary tumor, histological type, lymphovascular invasion (LVI), and ultrasonography BI-RADS classification of the primary tumor. The number of metastatic lymph nodes, size of the largest metastatic lymph node and the number of micrometastatic lymph nodes were also noted in the false-negative group. Results: There were 152 patients with normal preoperative AUS in the study group. The false-negative AUS rate was 20.4%. The incidence of invasive lobular carcinoma (ILC) and the mean tumor size was significantly greater in the false-negative group. Micrometastasis was present in 3 patients (3/31, 9.6%), the mean of the largest metastatic lymph nodes was 12.5 mm, the mean total number of malignant lymph nodes was 1.9 in the false-negative group. In 25/31 (80.6%) of the patients, there were less than or equal to 2 metastatic lymph nodes. The presence of LVI was higher in the false-negative group. There was no significant difference between the groups in terms of the other parameters. Conclusion: Before stating that the axilla is normal on ultrasonography, a careful evaluation should be made in patients with a mass >2 cm in size and/ or ILC diagnosis.

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“…Predicting the axillary lymph node status in patients with newly diagnosed breast cancer is an integral component of breast cancer management, including the staging, treatment plan, and prognosis [ 48 ]. Ultrasonography has been performed for the noninvasive preoperative evaluation of the axillary nodal basin because it is widely available and easily incorporated into the standard workup for breast cancer patients [ 49 ]. Ultrasonographic criteria based on size or morphologic characteristics have shown variable diagnostic performance for metastatic lymph nodes [ 50 ].…”

Section: Clinical Applications Of Swementioning

confidence: 99%

Shear-wave elastography in breast ultrasonography: the state of the art

2017

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Shear-wave elastography (SWE) is a recently developed ultrasound technique that can visualize and measure tissue elasticity. In breast ultrasonography, SWE has been shown to be useful for differentiating benign breast lesions from malignant breast lesions, and it has been suggested that SWE enhances the diagnostic performance of ultrasonography, potentially improving the specificity of conventional ultrasonography using the Breast Imaging Reporting and Data System criteria. More recently, not only has SWE been proven useful for the diagnosis of breast cancer, but has also been shown to provide valuable information that can be used as a preoperative predictor of the prognosis or response to chemotherapy.

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Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention?

Cited by 24 publications

References 37 publications

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

The Value of Ultrasound Diagnosed Axillary Lymph Node in Avoiding Axillary Surgery in Early Breast Cancer Patients

Histopathological and Tumor Characteristics Associated with False Negative Axillary Ultrasonography Results in Breast Cancer

Shear-wave elastography in breast ultrasonography: the state of the art

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