Axillary Ultrasound as Preoperative Staging in Clinical Negative Axillary Lymph Node Breast Cancer Patient

2021 ◽  
Vol 15 (5) ◽  
pp. 1222-1224
Author(s):  
M. S. Javid ◽  
M. Barry
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Preoperative Staging ◽  
Nodal Status ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Nodal Disease ◽  
Axillary Ultrasound

Objective: To determine the diagnostic accuracy of axillary US as a preoperative investigation by comparing it with the histology outcome of nodal status. Methods: This validation analysis was conducted in Mater Misericordia university hospital, Dublin Ireland form Feb 2007 to Feb 2015. All female patients with impalpable axillary lymph node and histology proven unifocal breast cancer between ages 18 to 75 years were included. Patients with the diagnosis of breast cancer were followed with Ultrasound imaging and results in Picture Archiving and communication system (PACS) and histology was confirmed using the patient center data base in both preoperative and postoperative course of breast cancer, including both sentinel lymph nodes and axillary lymph nodes. Results: A total of 625 patients had axillary ultrasound (US) to assess the preoperative axillary nodal status with mean age of 56±12 years. cN0 was diagnosed in 469 (75%) cases, cN1 in 136 (21.8%) cases and cN2 in 20 (3.2%) cases. After negative axillary ultrasound cN0 pathology shows positive pN2 and pN3 disease in 14 (2.9%) cases with the NPV of 97.01%. Axillary ultrasound had shown cN1 disease in 136 cases with the pathology outcome of pN2 and pN3 in 41 (30.14%) cases with the negative predictive value (NPV) of 69.85%. The overall sensitivity and specificity of the axillary US in detection of the positive node was 51.6% and 92.8% with PPV of 82.69% and NPV of 74.2%. Conclusion: Axillary US is a useful modality for screening of breast cancer patients. The negative US findings exclude the presence of advanced nodal disease. However, it cannot accurate distinguish between pN1 and pN2 or pN3 nodal disease. Keywords: Axillary ultrasound, Axillary lymph nodes, Breast cancer.

scholarly journals Dedicated Axillary MRI-Based Radiomics Analysis for the Prediction of Axillary Lymph Node Metastasis in Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 757
Author(s):  
Sanaz Samiei ◽  
Renée W. Y. Granzier ◽  
Abdalla Ibrahim ◽  
Sergey Primakov ◽  
Marc B. I. Lobbes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Axillary Lymph Node Metastasis ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Mr Images ◽  
Node Metastasis

Radiomics features may contribute to increased diagnostic performance of MRI in the prediction of axillary lymph node metastasis. The objective of the study was to predict preoperative axillary lymph node metastasis in breast cancer using clinical models and radiomics models based on T2-weighted (T2W) dedicated axillary MRI features with node-by-node analysis. From August 2012 until October 2014, all women who had undergone dedicated axillary 3.0T T2W MRI, followed by axillary surgery, were retrospectively identified, and available clinical data were collected. All axillary lymph nodes were manually delineated on the T2W MR images, and quantitative radiomics features were extracted from the delineated regions. Data were partitioned patient-wise to train 100 models using different splits for the training and validation cohorts to account for multiple lymph nodes per patient and class imbalance. Features were selected in the training cohorts using recursive feature elimination with repeated 5-fold cross-validation, followed by the development of random forest models. The performance of the models was assessed using the area under the curve (AUC). A total of 75 women (median age, 61 years; interquartile range, 51–68 years) with 511 axillary lymph nodes were included. On final pathology, 36 (7%) of the lymph nodes had metastasis. A total of 105 original radiomics features were extracted from the T2W MR images. Each cohort split resulted in a different number of lymph nodes in the training cohorts and a different set of selected features. Performance of the 100 clinical and radiomics models showed a wide range of AUC values between 0.41–0.74 and 0.48–0.89 in the training cohorts, respectively, and between 0.30–0.98 and 0.37–0.99 in the validation cohorts, respectively. With these results, it was not possible to obtain a final prediction model. Clinical characteristics and dedicated axillary MRI-based radiomics with node-by-node analysis did not contribute to the prediction of axillary lymph node metastasis in breast cancer based on data where variations in acquisition and reconstruction parameters were not addressed.

scholarly journals Omitting radiotherapy is safe in breast cancer patients ≥ 70 years old after breast-conserving surgery without axillary lymph node operation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ying Zhong ◽  
Yali Xu ◽  
Yidong Zhou ◽  
Feng Mao ◽  
Yan Lin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Breast Conserving Surgery ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Metastasis Rate

Abstract To verify whether omitting radiotherapy from breast cancer treatment for patients ≥ 70 years old following breast-conserving surgery (BCS) without axillary lymph node dissection is safe. Previous studies have shown that omitting breast radiotherapy after BCS and axillary lymph node dissection is safe for elderly breast cancer patients. We aimed to evaluate the safety of BCS without axillary surgery or breast radiotherapy (BCSNR) in elderly patients with breast cancer and clinically negative axillary lymph nodes. We performed a retrospective analysis of 481 patients with breast cancer, aged ≥ 70 years, between 2010 and 2016. Of these, 302 patients underwent BCSNR and 179 underwent other, larger scope operations. Local recurrence rate, ipsilateral breast tumor recurrence (IBTR) rate, distant metastasis rate, breast-related death, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. After a median follow-up of 60 months, no significant differences in local recurrence, distant metastasis rate, breast-related death, and DFS were noted. The OS was similar (P = 0.56) between the BCSNR group (91.7%) and other operations group (93.0%). The IBTR rate was considered low in both groups, however resulted greater (P = 0.005) in the BCSNR group (5.3%) than in other operations group (1.6%). BCSNR did not affect the survival of elderly patients with breast cancer with clinically negative axillary lymph nodes. IBTR was infrequent in both groups; however, there was a significant difference between the two groups. BCSNR is a feasible treatment modality for patients with breast cancer ≥ 70 years old with clinically negative axillary lymph nodes.

scholarly journals Value of Ultrasound in Evaluation of Abnormal Axillary Lymph Node

2021 ◽  
Vol 4 ◽  
pp. 3
Author(s):  
Abdelmohsen Radwan Hussien ◽  
Monaliza El-Quadi ◽  
Avice Oconnell
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cancer Treatment ◽  
Axillary Lymph Node ◽  
Breast Cancer Treatment ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph

Understanding of the various appearances of axillary lymph nodes (LNs) is essential for diagnosing and planning of breast cancer treatment. In this article, the role of ultrasound in detecting abnormal appearing metastatic LNs s is discussed, with emphasis on most of the ultrasonographic features and tools which might help improve detection of axillary LN pathology.

Do All Women with Abnormal Sonographic Axillary Lymph Nodes Need a Biopsy?

2016 ◽  
Vol 67 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Yoav Amitai ◽  
Tehillah Menes ◽  
Galit Aviram ◽  
Orit Golan
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Needle Biopsy ◽  
Systemic Disease ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
History Of ◽  
Axillary Mass

Purpose With the increased use of breast ultrasound for different indications, sonographically abnormal axillary lymph nodes are not a rare finding. We examined clinical and imaging characteristics in correlation with pathological reports of the sonographic guided biopsies to assess the yield of needle biopsy of these nodes. Methods Clinical, imaging and pathology data were collected for 171 consecutive patients who underwent sonographic guided needle biopsy of an abnormal lymph node between 2008 and 2013. Malignancy rates were examined for different clinical settings: palpable axillary mass, previous history of breast cancer, findings suggestive of a systemic disease, and those with a breast finding of low suspicion or an incidental abnormal axillary lymph node. Patients with newly diagnosed breast cancer were excluded. Results Twelve patients (7%) were found to have a malignancy on their axillary lymph node biopsy. Malignancy rates increased with age, and varied with clinical presentation: Axillary mass (8, 26%); history of breast cancer (2, 11%); systemic disease (0%) and breast finding of low suspicion or incidental abnormal lymph node on screening (1, 1%). Low rates of malignancy were found when the cortex was <6 mm (1, 0.8%). The most important imaging finding associated with malignancy was lack of a preserved hilum, in which case almost a third (10, 29%) of the biopsies were malignant. Only 1 of 89 women with a breast finding of low suspicion or an incidental abnormal axillary lymph node was found to have malignancy. In this case the lymph node had no hilum. Conclusions In women without breast cancer, a highly suspicious breast mass or an axillary mass, more stringent criteria should be used when evaluating an abnormal axillary lymph node on sonography, as the malignancy rates are very low (1%).

Comparing study of positron emission tomography and ultrasonography in the detection of axillary lymph node metastasis in patients with early stage breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 616-616 ◽  
Author(s):  
B. Song ◽  
J. Bae ◽  
J. Kim ◽  
H. Jeon ◽  
S. Jung
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Ct Imaging ◽  
Axillary Lymph Nodes ◽  
Lymph Node Staging ◽  
Axillary Lymph ◽  
Pet Ct ◽  
Breast Sonography

616 Background: The current status of axillary lymph node is the most important prognostic factor in breast cancer. Axillary lymph node dissection (ALND) is currently the standard option for assessment of axillary lymph nodes. Positron emission tomography - computerized tomography (PET-CT) imaging and breast sonography are a noninvasive imaging modality that can detect malignant lymph node. The purpose of this study was to evaluate the clinical usefulness of axillary lymph node staging by means of PET-CT imaging compare with breast sonography in breast cancer. Methods: This study involves 129 breast cancer patients and clinically negative axillary node. All patients had whole body PET-CT imaging and breast sonography before SLN biopsy. After SLN biopsy, all patients underwent complete ALND. Axillary lymph nodes were evaluated by standard hematoxylin and eosin staining techniques, while sentinel nodes were further examined for micrometastatic disease. The findings of PET-CT imaging and breast sonography of 129 patients were compared with pathologic findings after operation. Diagnostic accuracy was evaluated applying ROC curve areas. Results: The sensitivity of PET-CT imaging was 60.0%; specificity and accuracy were 83.6% and 73.4%, respectively. The sensitivity, specificity and accuracy of breast sonography were 61.8%, 89.0%, and 77.3% respectively. The SUVs of axillary lymph node ranged from 0.0 to 7.01. Analysis using ROC curves revealed the area under each curve which indicated a diagnostic accuracy. For involvement of axillary lymph node, PET-CT imaging had the area under the curve of 0.735, breast sonography one of 0.769. Conclusions: Axillary lymph node staging using PET-CT imaging is inferior to the breast sonography in early stage of breast cancer patients. Our study reveals the value of PET-CT imaging is not good compare to the breast sonography in the detection of axillary lymph nodes metastasis in patients with early breast cancer. No significant financial relationships to disclose.

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

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.

scholarly journals DIAGNOSTIC VALUUE OF FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) BIOPSY AND LYMPH NODES IN BREAST TUMOURS

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Surendra Kumar Dhruv
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Needle Aspiration ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Ultrasound Guided ◽  
Aspiration Cytology ◽  
Needle Aspiration Cytology

INTRODUCTION:  Breast cancer is the most common solid cancer in women and one of the leading causes of cancer deaths in the western countries. In India it is a leading cause for mortality and morbidity. Prognosis of invasive ductal carcinoma (IDC) of breast is determined by anatomic extent of the disease and can be assessed by tumor size, lymph node status and metastasis, also biologic markers such as histological grade, hormone receptor expression, HER2 overexpression, and/or amplification and genomic panels can be used. The presence of metastatic in axillary lymph nodes confirms the capacity of a cancer to metastasize. It represents the single most prognostically potent element of clinical stage in potentially curable cases. Axillary lymph node dissection and histological evaluation has a continuing place in the staging and management of patients with breast cancer. It has been shown that cytological grade correlates well with the axillary lymph nodal metastasis and also prognosis. Axillary lymph node evaluation in breast cancer is usually performed preoperatively by clinical examination, sonography, lymph node resection and by ultrasound-guided fine-needle aspiration cytology. MATERIAL AND METHODS: Patients with detected breast mass (palpable and non-palpable) and palpable axillary lymph node who were evaluated by FNAC. After sterile draping and sufficient disinfection, a 10-ml syringe was inserted into and withdrawn from the lymph node three times under aspiration while sonographically monitored. The procedure was performed by using 21-22 Gauge needle with 2–4 aspirations and it was repeated if the sample was inadequate. Ultrasound guided FNAC was performed for impalpable, and deeply located small lumps. RESULTS: A total of 156 patients were underwent for FNAC of the breast lump. Histological correlation of all the patients was done. The mean age of patients who underwent FNAC was 39.6 ± 9.42 years and all were female patients. The cytology reports were classified as benign, atypical, suspicious, malignancy, and unsatisfactory. In 59 (37.8%) cases benign lesions were observed of which the fibrocystic disease was the most common cytological diagnosis. 15 (9.6%) were atypical, 7(4.5%) were suspicious and in 72(46.2%) cases malignancy was diagnosed. In 3 (1.9%) cases sample was unsatisfactory. FNAC of the axillary lymph nodes was performed on 76 patients with palpable lymph nodes and histological correlation of axillary lymph node. In FNAC and histology correlation of axillary lymph node sensitivity was 81.94% (95% CI 71.11% to 90.02%) and specificity was 100% (95% CI39.76% to 100.00%) with positive predictive value of 100%. CONCLUSION: FNAC is a rapid, cost effective and safe procedure for management of breast lumps.

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