Accuracy of Individual Descriptors and Grading of Nodal Involvement by Axillary Ultrasound in Patients of Breast Cancer

Background. Four-node sampling is a useful substitute for sentinel node biopsy in low resource settings. USG is being increasingly used as a preoperative tool to evaluate axilla. We conducted this study to assess the accuracy of different descriptors of axillary ultrasound and to formulate a model on grading of axillary involvement.Material and Methods. Thirty-four patients with clinically negative axilla underwent preoperative axillary ultrasound. The suspicious nodes were marked and details of various descriptors were noted. These nodes were sampled during axillary dissection and correlation of ultrasonographic findings with histopathological report was done to calculate accuracy of different descriptors. Based on this, a grading system of axillary lymph nodes involvement was formulated.Results. Based on the presence of various descriptors, five grades of nodal involvement could be defined. The most accurate descriptors to indicate nodal involvement were loss of hilar fat and hypoechoic internal echoes with specificity of 83% and positive predictive value of 92% each. The combination of descriptors of round shape with loss of hilar fat and hypoechoic internal echos had 100% specificity and positive predictive value.Conclusions. Grading of nodal involvement on axillary USG can be useful for selecting the most suspicious nodes for sampling during axillary dissection.

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A Decision Tree To Predict Four or More Positive Axillary Lymph Nodes in Breast Cancer Patients with Positive Sentinel Node Biopsy: Determining Necessity for Regional Nodal Irradiation in the Absence of Axillary Dissection.

10.1158/0008-5472.sabcs-09-1026 ◽

2009 ◽

Author(s):

R. Macrorie-Fairweather ◽

K. Albuquerque ◽

K. Yao ◽

J. Sinacore

Keyword(s):

Breast Cancer ◽

Decision Tree ◽

Cancer Patients ◽

Axillary Dissection ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Positive Sentinel Node ◽

Breast Cancer Patients ◽

Regional Nodal Irradiation ◽

Node Biopsy

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Negative predictive value of ipsilateral axillary ultrasound in the pre-operative assessment of invasive breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12080 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e12080-e12080 ◽

Cited By ~ 2

Author(s):

Bita Ameri ◽

Riti Kanesa-Thasan ◽

Maysa M. Abu-Khalaf ◽

Adam C. Berger ◽

Tara Eisenberg ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Negative Predictive Value ◽

Invasive Breast Cancer ◽

Predictive Value ◽

Lymph Node Biopsy ◽

Axillary Lymph ◽

Axillary Ultrasound ◽

Node Biopsy

e12080 Objective: To determine if a negative preoperative axillary ultrasound predicts a negative sentinel lymph node biopsy at surgery. Background: Axillary lymph node involvement is an important prognostic indicator in patients with breast cancer. Sentinel lymph node biopsy (SLNB) is currently the gold standard for determining the presence or absence of axillary metastases. Pre-operative axillary ultrasound is often used to evaluate axillary lymph node status prior to surgery and SLNB. Although there are no established guidelines on when preoperative axillary ultrasound is performed, at our institution we evaluate the axilla when invasive breast cancer is suspected. This study evaluated the negative predictive value (NPV) of axillary ultrasound compared to the pathology results of SLNB. Methods: In this single-center IRB-approved retrospective study, 3 years of breast imaging data (2014-2016) were reviewed. 137 patients had pathology verified invasive breast cancer with negative preoperative axillary ultrasound and subsequent SLNB. All patients had clinically negative axillae. Based upon the pathology results of SLNB, the negative predictive value of preoperative axillary ultrasound was calculated. Negative axillary ultrasound is defined as the absence of morphologically abnormal lymph nodes on imaging. A lymph node is considered morphologically normal when there is preserved fatty hilum and a uniform cortex measuring 3 mm or less. Results: Out of 137 patients with invasive breast cancer who had negative preoperative axillary ultrasound, 122 had negative SLNB results and 15 had positive SLNB results. Preoperative axillary ultrasound demonstrated a NPV of 89.1% for the detection of axillary metastatic disease at the time of SLNB. Conclusions: Negative axillary ultrasound excluded axillary metastatic disease in 89.1% of patients. This data suggests that negative axillary ultrasound may have a role in the setting of failed SLNB (no lymph nodes found at the time of surgery) in deciding whether to pursue axillary dissection.

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Correlation between preoperative axillary ultrasound and histopathology of resected lymph nodes in patients with carcinoma breast

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20185387 ◽

2018 ◽

Vol 7 (1) ◽

pp. 236

Author(s):

Ab. Hamid Wani ◽

Anish Gupta ◽

Nasib Chand Dhigra ◽

Narinder Sing ◽

Javid Iqbal

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Predictive Value ◽

Axillary Lymph Node ◽

Axillary Lymph Nodes ◽

Lymph Node Status ◽

Axillary Lymph ◽

Axillary Ultrasound ◽

Carcinoma Breast ◽

Node Status

Background: Axillary Ultrasound is an important tool in assessing regional lymph node status in women who are node negative clinically as many of them will prove to have axillary lymph node involvement on histopathology. The aim of the present study was to establish the role of axillary ultrasound in preoperative assessment of lymph node status in women with carcinoma breast and to correlate the findings of axillary ultrasound with the histopathology of resected axillary nodes.Methods: Forty patients (all women) were included in this study and the preoperative axillary ultrasound was done to know the status of axillary lymph nodes and the findings were correlated with histopathological findings of the resected nodes.Results: The sensitivity of axillary ultrasound was found to be 66.67%, specificity was 87.5%, accuracy 75%, positive predictive value (PPV) of 88.89% and negative predictive value of 63.4%.Conclusions: Axillary ultrasound is very important tool in assessing preoperative axillary lymph node status in patients with carcinoma breast. It is also important in assessment after inadequate axillary dissection and for follow up of non-treated axilla.

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Axillary lymph node status in breast cancer staging: What patient and tumor factors affect the accuracy of ultrasound-guided fine needle aspiration?

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.1126 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 1126-1126

Author(s):

Celin Chacko ◽

Beatriu Reig ◽

Tova Koenigsberg

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Predictive Value ◽

Axillary Dissection ◽

Lymph Node Biopsy ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Ultrasound Guided

1126 Background: The purpose of the study is to evaluate the accuracy of ultrasound-guided fine needle aspiration (FNA) of axillary lymph nodes(ALNs) in patients with breast cancer and to determine factors that influence accuracy of ultrasound-guided FNA. Methods: Retrospective review of patients with breast cancer who had FNA of ALNs as well as sentinel lymph node excision or complete axillary dissection. Patients treated with neoadjuvant chemotherapy were excluded. 55 axillary FNAs in 54 patients were included in the final analysis. Pathology reports were reviewed for size of the primary tumor, FNA results, number of positive ALNs, and greatest tumor size in ALNs. FNA was performed if a suspicious lymph node was identified. Surgical sentinel lymph node biopsy or full axillary dissection were the reference standard. Micrometastases (< 0.2 mm) and isolated tumor cells in the lymph node were included in the negative group. Atypical and nondiagnostic FNA results were considered negative cytologic results. Significance was analyzed using the Mann-Whitney test. Results: Size of the primary cancer ranged from 0.3 mm to 8.5 cm. The sensitivity of FNA was 73%, with positive predictive value of 97% and negative predictive value of 52%. The NPV of FNA for primary tumors <1 cm, 1.1-2, 2.1-5 and >5 cm is 100%, 36%, 50% and 66% respectively. Correlation of primary tumor size with sensitivity of FNA was not statistically significant. The sensitivity of FNA for lymph nodes with metastatic deposit < 5mm, 6-10mm, 11-15mm, 16-20mm, and 21mm+ is 0%, 57%, 59%, 89%, and 100%, which is statistically significant (p = 0.007). The number of positive ALNs at axillary dissection is not correlated to the sensitivity of FNA. The sensitivity of FNA for 1-3, 4-9 and 10+ positive ALNs is 78%, 64% and 80%. Conclusions: Our findings indicate that FNA of suspicious axillary lymph nodes is valuable even in small tumors, which differs from the literature. The overall negative predictive value of FNA is 52%, so sentinel lymph node biopsy is essential after negative FNA. Sensitivity of FNA increases with the size of the metastatic deposit in the lymph node, but is not correlated to the number of positive ALNs found at dissection.

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An AN OBSERVATIONAL STUDY OF SLN MAPPING IN PATIENTS OF LOCALLY ADVANCED BREAST CANCER FOLLOWING NCT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.899 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Ankur Garg ◽

Udbhav Kathpalia ◽

Shweta Bansal ◽

Manoj Andley ◽

Sudipta Saha

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Adjuvant Chemotherapy ◽

Lymph Nodes ◽

Locally Advanced ◽

Lymph Node Biopsy ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Biopsy ◽

Neo Adjuvant Chemotherapy

Background : Locally advanced breast carcinoma (LABC) includes a wide range of clinical scenarios- advanced primary tumors (T4), advanced nodal disease and inflammatory carcinomas(1). Traditionally, treatment of LABC included a combination of Chemotherapy, Radiation and Surgery(2). However, there has been a shift to Neoadjuvant Chemotherapy in recent times.(3) Histological status and the number of axillary lymph nodes with metastasis is one of the most important prognostic factors and most powerful predictor of recurrence and survival in patients of breast carcinoma and remains so, even after neo-adjuvant chemotherapy. (3) Information derived from the sentinel lymph node is considered valuable, with less discomfort to the patient when compared with axillary dissection.(4) However, its role in detecting nodal metastasis after neo-adjuvant chemotherapy in LABC is still debatable and definitive studies to evaluate its role are still evolving. (5) Materials and Methods: Patients of LABC were evaluated using ultrasonography (USG) of axilla. Neo-adjuvant chemotherapy (NACT) was administered and patients were reassessed by USG of axilla. Thirty patients with node negative axillary status were subjected to Sentinel lymph node mapping using isosulfan blue followed by Modified Radical Mastectomy and Axillary Lymph Node Dissection. Histopathological evaluation of stained and unstained lymph nodes done and the data, thus obtained, was statistically analysed. Results: Sentinel lymph node biopsy performed using Isosulfan Blue dye alone, after neo-adjuvant chemotherapy predicts the status of axillary lymph nodes with low accuracy. Conclusions: Further studies would be required to establish the role of sentinel lymph node biopsy in patients with LABC after NACT.

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Are Lymph Node Characteristics on Axillary Ultrasound Associated with ≥3 Positive Lymph Nodes in Patients Managed by the American College of Surgeons Oncology Group Z0011 Trial Criteria?

The American Surgeon ◽

10.1177/000313481808400726 ◽

2018 ◽

Vol 84 (7) ◽

pp. 1133-1137

Author(s):

Emma G. Rooney ◽

Margaret M. Fleming ◽

Jay G. Patel ◽

Kelly Clifford ◽

Chaejin Kim ◽

...

Keyword(s):

Lymph Node ◽

Cortical Thickness ◽

Breast Conserving Surgery ◽

Axillary Lymph ◽

Positive Finding ◽

Oncology Group ◽

Axillary Ultrasound ◽

Round Shape ◽

American College Of Surgeons ◽

Z0011 Trial

Patients often receive axillary ultrasound-biopsy (AUS-B) before clinical evaluation. One positive biopsy in the absence of palpable disease rarely indicates additional nodal involvement, but it eliminates patients from being managed by the American College of Surgeons Oncology Group Z0011 trial criteria. To determine which patients may benefit from AUS-B, we analyzed whether characteristics on AUS were associated with large-volume axillary disease and, thus, the need for axillary lymph node (LN) dissection. A retrospective review identified patients who met Z0011 criteria and underwent AUS. Clinicopathologic and ultrasound characteristics were compared between patients with ≤2 versus ≥3 positive LNs. Two hundred and seven patients with cT1-2N0 tumors underwent preoperative AUS and breast-conserving surgery. On multivariate analysis, three AUS combinations were associated with ≥3 positive LNs: cortical thickness (CT) > 4 mm + loss of fatty hilum + round shape (P = 0.0218), CT > 4 mm + loss of fatty hilum (P = 0.0211), and CT > 4 mm + round shape (P = 0.0155). Preoperative axillary LN biopsy in patients with a single abnormal LN characteristic on AUS may be unnecessary because a positive finding will eliminate management according to Z0011 criteria. Cortical thickness >4 mm combined with any other abnormal characteristic was associated with ≥3 positive LNs, supporting the performance of AUS-B in this population.

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Can We Identify or Exclude Extensive Axillary Nodal Involvement in Breast Cancer Patients Preoperatively?

Journal of Oncology ◽

10.1155/2019/8404035 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Martijn Leenders ◽

Gaëlle Kramer ◽

Kamar Belghazi ◽

Katya Duvivier ◽

Petrousjka van den Tol ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Cancer Patients ◽

Needle Biopsy ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Nodal Involvement ◽

Ultrasound Guided ◽

Axillary Ultrasound ◽

Pet Ct

Background. Breast cancer treatment has rapidly changed in the last few years. Particularly, treatment of patients with axillary nodal involvement has evolved after publication of several randomized clinical trials. Omitting axillary lymph node dissection in selected early breast cancer patients with one or two positive sentinel nodes did not compromise overall survival nor regional disease control in these trials. Hence, either excluding or identifying extensive axillary nodal involvement becomes increasingly important. Purpose. To evaluate whether the current diagnostic modalities can accurately identify or exclude extensive axillary nodal involvement. Evaluated modalities were axillary ultrasound, ultrasound-guided needle biopsy, MRI, and PET/CT. Methods. A literature search was performed in the Cochrane Library, EMBASE, and PubMed databases up to June 2019. The search strategy included terms for breast cancer, lymph nodes, and the different imaging modalities. Only articles that reported pathological N-stage or the total number of positive axillary lymph nodes were considered for inclusion. Studies with patients undergoing neoadjuvant systemic therapy were excluded. Conclusion. There is no evidence that any of the current preoperative axillary imaging modalities can accurately exclude or identify breast cancer patients with extensive nodal involvement. Both negative PET/CT and negative MRI scans (with gadolinium-based contrast agents) are promising in excluding extensive nodal involvement. Larger studies should be performed to strengthen this conclusion. False-negative rates of axillary ultrasound and ultrasound-guided needle biopsy are too high to rely on negative results of these modalities in excluding extensive nodal involvement.

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