Should the Axilla Be Included in Screening US?

Ferré, Romuald; AlSharif, Shaza; Paré, Martine; Kao, Ellen; Mesurolle, Benoı̂t

doi:10.1148/radiol.14141792

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…We derived a dataset of female breast cancer patients diagnosed from 2010 to 2013, for the reason of known HER2 status and follow-up time. The inclusion criteria were as follows: females aged over 18 years old; American Joint Committee on Cancer stages (the seventh AJCC System) TNM stage I–III;21,22 unilateral breast cancer; breast cancer as the first and only cancer diagnosis; TCNP or tumor in the breast peripheral quadrant (TBPQ) (including UOQ, UIQ, lower outer quadrant, LIQ, but overlapping sites were excepted); diagnosis not obtained from a death certificate or autopsy; pathologic confirmation of breast cancer; known tumor differentiation status (histological score);23–25 known HR and HER2 status;26–28 known tumor size and LN status; known surgery type; known radiation/chemotherapy; and active follow-up. Patients with incomplete information were excluded.…”

Section: Methodsmentioning

confidence: 99%

<p>Tumor location of the central and nipple portion is associated with impaired survival for women with breast cancer</p>

Ji¹,

Xiao²,

Yang³

et al. 2019

CMAR

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Background Tumor location in the breast varies, with the highest frequency in the upper outer quadrant and lowest frequency in the lower inner quadrant. Nevertheless, tumors in the central and nipple portion (TCNP) are poorly studied types of breast cancer; therefore, we aimed to clarify the clinicopathological characteristics and prognostic features of TCNP. Methods Using the Surveillance, Epidemiology, and End Results database, we identifed 105,037 patients diagnosed with tumor in the breast peripheral quadrant (TBPQ) (n=97,046) or TCNP (n=7,991). The chi-squared test was used to compare categorical variables across TCNP and TBPQ. Cox proportional hazard models with hazard ratios were applied to estimate the factors associated with prognosis. Results The median follow-up was over 43 months. Compared with TBPQ, TCNP patients were signifcantly older (age ≥66 years: 40.4% vs 34.1%, P<0.001), with larger tumor sizes (>20 mm size: 46.9% vs 37.3%, P<0.001), higher proportions of TNM stage II–III (18.6% vs 9.9%, P<0.001), and more mastectomies (58.1% vs 37.8%, P<0.001). The breast cancer-specifc survival (BCSS)/overall survival (OS) rate was signifcantly worse for TCNP than for TBPQ. Multivariate Cox analysis showed a higher hazard ratios for TCNP over TBPQ (BCSS: hazard ratios =1.160, P=0.005, 95% CI: 1.046–1.287; OS: hazard ratios =1.301, P<0.001, 95% CI: 1.211–1.398). A subgroup analysis revealed inferior outcomes for TCNP in TNM stage II–III and breast subtype subgroup. Multivariate logistic regression indicated that TCNP was an independent contributing factor to LN metastasis. Conclusions TCNP was associated with older age, larger tumor size, higher TNM stage, and lymph node metastasis. Compared with TBPQ, TCNP had adverse impacts on BCSS and OS.

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Section: Methodsmentioning

confidence: 99%

<p>Tumor location of the central and nipple portion is associated with impaired survival for women with breast cancer</p>

Ji¹,

Xiao²,

Yang³

et al. 2019

CMAR

View full text Add to dashboard Cite

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“…The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) atlas suggested that the axilla could be scanned as well the breast parenchyma. 20 , 21 For the suspicious finding of the axilla in screening, Okubo et al 9 suggested that magnetic resonance imaging (MRI) and positron emission tomography could aid in the preoperative diagnosis of CATS, although the utility of positron emission tomography in the suspected breast cancer patients has not been established due to the high cost and radiation. MRI is a more practical imaging method for the accurate diagnosis of CATS.…”

Section: Discussionmentioning

confidence: 99%

Decreased survival in patients with carcinoma of axillary tail versus upper outer quadrant breast cancers: a SEER population-based study

Gou¹,

Liu²,

Xiao³

et al. 2018

CMAR

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BackgroundCarcinoma of the axillary tail of Spence (CATS) is a poorly studied type of breast cancer. The clinicopathological characteristics and prognostic features of CATS are unclear.MethodsUsing the Surveillance, Epidemiology, and End Results database, we identified 149,026 patients diagnosed with upper outer quadrant breast cancer (UOBC) (n=146,343) or CATS (n=2,683). The median follow-up was 88 months. The primary and secondary outcomes were breast cancer-specific survival (BCSS) and overall survival. The survival outcomes of UOBC and CATS were compared using competing risks analysis, log-rank test, Cox proportional hazards regression model, and propensity score matching method. Multivariate logistic regression was utilized to present the relationship between CATS and lymph node (LN) metastasis.ResultsCATS presented a higher grade, higher negative hormone receptor rate, and more positive nodal metastasis. The 10-year BCSS rate was worse for CATS than for UOBC (85.1% vs 87.3%, P=0.001). The multivariate Cox analysis showed a higher hazard ratio (HR) for CATS over UOBC (BCSS: HR =1.20, P=0.001; overall survival: HR =1.11, P=0.019). The difference in the BCSS was also observed in a 1:1 matched cohort (BCSS P=0.019). A subgroup analysis revealed the inferior outcomes of CATS in the metastatic LN subgroup and the hormone receptor-negative subgroup. The multivariate logistic regression indicated that CATS is an independent contributing factor to LN metastasis.ConclusionCATS had distinct clinicopathological characteristics and was more likely associated with LN metastasis. Compared to UOBC, CATS had adverse impacts on BCSS.

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“…The axillary region can be included when breast US is performed with a handheld device. Scanning of the axilla is considered optional because it may increase scanning time and result in more false-positive findings (18,19). However, the bilateral axillae are routinely scanned and representative images are documented in many institutions when handheld breast US is performed because breast cancers have been known to manifest as an isolated axillary nodal metastasis without any clinically or radiologically detectable breast tumors (20), and various lesions, both benign and malignant, can develop in the accessory breast tissue, which is present…”

Section: Study Populationmentioning

confidence: 99%

Supplemental Screening Breast US in Women with Negative Mammographic Findings: Effect of Routine Axillary Scanning

Lee

Jang

et al. 2018

Radiology

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Purpose To evaluate the effect of routine axillary scanning when supplemental screening breast ultrasonography (US) is performed in women with negative mammographic findings. Materials and Methods This retrospective review included 12 844 screening breast US examinations performed in 8664 asymptomatic women aged 40 years or older with dense breasts and negative results for cancer at mammography performed between January 2012 and December 2014. Bilateral whole-breast US was performed with a handheld device by one of 10 experienced radiologists. The bilateral axillae were routinely scanned, and representative images were documented in all examinations. The abnormal interpretation rate (AIR), cancer detection rate (CDR), and positive predictive value (PPV) of screening breast US with and without axillary scanning were calculated. The 95% confidence intervals (CIs) were calculated for cancer detection after an abnormal finding at screening US. Results The frequency of positive axillary findings was 3.5 per 1000 (14 of 4009) baseline screening US examinations and 2.2 per 1000 (19 of 8835) subsequent screening US examinations. Of the 33 women with 33 positive axillary findings, 11 had positive breast findings; none were diagnosed with breast cancer. The remaining 22 women showed positive findings only in the axilla. The axillary findings revealed no malignancy at biopsy (n = 12) or during 22-54-month follow-up (n = 21) (95% CI: 0%, 10.6%). Without routine axillary scanning, the AIR of screening US decreased from 15.2% (610 of 4009 examinations) to 15.0% (602 of 4009 examinations) at baseline US and from 8.1% (714 of 8835 examinations) to 7.9% (700 of 8835 examinations) at subsequent US examinations, and the PPV for biopsy performed increased from 6.0% (five of 83 examinations) to 6.4% (five of 78 examinations) at baseline US and from 7.6% (13 of 170 examinations) to 7.9% (13 of 164 examinations) at subsequent US examinations, without a change in the CDR. Conclusion Routine axillary scanning during screening breast US had no effect on additional cancer detection, but rather increased the number of false-positive results. However, the conclusions based on these findings must be tempered by the low rate of positive findings. RSNA, 2017.

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Should the Axilla Be Included in Screening US?

Cited by 6 publications

References 8 publications

<p>Tumor location of the central and nipple portion is associated with impaired survival for women with breast cancer</p>

<p>Tumor location of the central and nipple portion is associated with impaired survival for women with breast cancer</p>

Decreased survival in patients with carcinoma of axillary tail versus upper outer quadrant breast cancers: a SEER population-based study

Supplemental Screening Breast US in Women with Negative Mammographic Findings: Effect of Routine Axillary Scanning

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