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Polat DS, Nguyen S, Karbasi P, Hulsey K, Cobanoglu MC, Wang L, Montillo A, Dogan BE. Machine Learning Prediction of Lymph Node Metastasis in Breast Cancer: Performance of a Multi-institutional MRI-based 4D Convolutional Neural Network. Radiol Imaging Cancer 2024; 6:e230107. [PMID: 38607282 PMCID: PMC11148663 DOI: 10.1148/rycan.230107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Purpose To develop a custom deep convolutional neural network (CNN) for noninvasive prediction of breast cancer nodal metastasis. Materials and Methods This retrospective study included patients with newly diagnosed primary invasive breast cancer with known pathologic (pN) and clinical nodal (cN) status who underwent dynamic contrast-enhanced (DCE) breast MRI at the authors' institution between July 2013 and July 2016. Clinicopathologic data (age, estrogen receptor and human epidermal growth factor 2 status, Ki-67 index, and tumor grade) and cN and pN status were collected. A four-dimensional (4D) CNN model integrating temporal information from dynamic image sets was developed. The convolutional layers learned prognostic image features, which were combined with clinicopathologic measures to predict cN0 versus cN+ and pN0 versus pN+ disease. Performance was assessed with the area under the receiver operating characteristic curve (AUC), with fivefold nested cross-validation. Results Data from 350 female patients (mean age, 51.7 years ± 11.9 [SD]) were analyzed. AUC, sensitivity, and specificity values of the 4D hybrid model were 0.87 (95% CI: 0.83, 0.91), 89% (95% CI: 79%, 93%), and 76% (95% CI: 68%, 88%) for differentiating pN0 versus pN+ and 0.79 (95% CI: 0.76, 0.82), 80% (95% CI: 77%, 84%), and 62% (95% CI: 58%, 67%), respectively, for differentiating cN0 versus cN+. Conclusion The proposed deep learning model using tumor DCE MR images demonstrated high sensitivity in identifying breast cancer lymph node metastasis and shows promise for potential use as a clinical decision support tool. Keywords: MR Imaging, Breast, Breast Cancer, Breast MRI, Machine Learning, Metastasis, Prognostic Prediction Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Dogan S Polat
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M., B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W., A.M.), and Biomedical Engineering Department (A.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Son Nguyen
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M., B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W., A.M.), and Biomedical Engineering Department (A.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Paniz Karbasi
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M., B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W., A.M.), and Biomedical Engineering Department (A.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Keith Hulsey
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M., B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W., A.M.), and Biomedical Engineering Department (A.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Murat Can Cobanoglu
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M., B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W., A.M.), and Biomedical Engineering Department (A.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Liqiang Wang
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M., B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W., A.M.), and Biomedical Engineering Department (A.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Albert Montillo
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M., B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W., A.M.), and Biomedical Engineering Department (A.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Basak E Dogan
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M., B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W., A.M.), and Biomedical Engineering Department (A.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
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Dialani V, Dogan B, Dodelzon K, Dontchos BN, Modi N, Grimm L. Axillary Imaging Following a New Invasive Breast Cancer Diagnosis-A Radiologist's Dilemma. JOURNAL OF BREAST IMAGING 2021; 3:645-658. [PMID: 38424939 DOI: 10.1093/jbi/wbab082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 03/02/2024]
Abstract
Traditionally, patients with newly diagnosed invasive breast cancer underwent axillary US to assess for suspicious axillary lymph nodes (LNs), which were then targeted for image-guided needle biopsy to determine the presence of metastasis. Over the past decade, there has been a shift towards axillary preservation. For patients with palpable lymphadenopathy, the decision to perform axillary imaging with documentation of the number and location of abnormal LNs in preparation for image-guided LN sampling is straightforward. Since LN involvement correlates with cancer size, it is reasonable to image the axilla in patients with tumors larger than 5 cm; however, for tumors smaller than 5 cm, axillary imaging is often deferred until after the tumor molecular subtype and treatment plan are established. Over the last decade, neoadjuvant chemotherapy (NACT) is increasingly used for smaller cancers with more aggressive molecular subtypes. In most cases, detecting axillary metastasis is critical when deciding whether the patient would benefit from NACT. There is increasing evidence that abnormal axillary US findings correlates with LN metastases and reliably establishes a baseline to monitor response to NACT. Depending on hormone receptor status, practices may choose to image the axilla in the setting of clinical stage T1 and T2 cancers to evaluate nodal status and help determine further steps in care. Radiologists should understand the nuances of axillary management and the scope and challenges of LN marking techniques that significantly increase the precision of limited axillary surgery.
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Affiliation(s)
- Vandana Dialani
- Beth Israel Lahey Hospital, Department of Radiology, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Basak Dogan
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Katerina Dodelzon
- Weill Cornell Medical College, Department of Radiology, New York, NY, USA
| | - Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Neha Modi
- Saint Vincent Hospital at Worcester Medical Center, Department of Radiology, Worcester, MA, USA
| | - Lars Grimm
- Duke University Hospital, Department of Radiology, Durham, NC, USA
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Jamaris S, Jamaluddin J, Islam T, See MH, Fadzli F, Rahmat K, Bhoo-Pathy N, Taib NAM. Is pre-operative axillary ultrasound alone sufficient to determine need for axillary dissection in early breast cancer patients? Medicine (Baltimore) 2021; 100:e25412. [PMID: 34106588 PMCID: PMC8133266 DOI: 10.1097/md.0000000000025412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
Pre-operative status of axillary lymph node (ALN) in early breast cancer is usually initially assessed by pre-operative ultrasound, followed by ultrasound-guided needle biopsy (UNB) confirmation. Patients with positive nodal status will undergo axillary lymph node dissection (ALND), while those with negative nodal status will have sentinel lymph node biopsy. ALND is associated with higher morbidity than Sentinel lymph node biopsy. The objective of this study is to determine if axillary ultrasound alone without UNB is predictive enough to assign patients to ALND and to identify ultrasound features that are significantly associated with pathologically positive ALN.383 newly diagnosed primary breast cancer patients between 2012 and 2014, and who had undergone pre-operative axillary ultrasound in University Malaya Medical Centre with a complete histopathology report of the axillary surgery were retrospectively reviewed. ALN was considered positive if it had any of these features: cortical thickening > 3 mm, loss of fatty hilum, hypoechoic solid node, mass-like appearance, round shape and lymph node size > 5 mm. Post-operative histopathological reports were then analyzed for nodal involvement.The overall sensitivity, specificity, and accuracy of pre-operative axillary ultrasound in detecting diseased nodes were 45.5%, 80.7%, and 60.3% respectively. The positive (PPV) and negative predictive values were 76.5% and 51.8%. Round shape, loss of fatty hilum and mass-like appearance had the highest PPVs of 87%, 83% and 81.6% respectively and significant odds ratios (ORs) of 5.22 (95% confidence interval [CI]: 1.52 - 17.86), ORs of 4.77 (95% CI: 2.62 - 8.70) and ORs of 4.26 (95% CI: 2.37 - 7.67) respectively (P-value < .05). Cortical thickness of > 3 mm was identified to have low PPV at 69.1%, ORs of 1.71 (95% CI: 0.86 - 3.41, P = .126).There are features on axillary ultrasound that confer high PPV for axillary involvement i.e. round shape, loss of fatty hilum, and mass-like appearance. In a low resource setting, these features may benefit from ALND without further pre-operative biopsies. However, pre-operative UNB for features with low PPV that is, cortical thickness > 3 mm should be considered to obviate the unnecessary morbidity associated with ALND.
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Affiliation(s)
| | | | | | | | | | | | - Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Diagnostic Accuracy of Axillary Ultrasound in Early–Stage Breast Cancer. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1828-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lesar M, Stanec M, Banović M. Significance of the Relative Size of a Breast Tumor in Deciding the Method of Surgical Treatment. TUMORI JOURNAL 2018. [DOI: 10.1177/030089160609200104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Miroslav Lesar
- Department of Surgical Oncology, University Hospital for Tumors, Zagreb, Croatia
| | - Mladen Stanec
- Department of Surgical Oncology, University Hospital for Tumors, Zagreb, Croatia
| | - Miroslav Banović
- Department of Surgical Oncology, University Hospital for Tumors, Zagreb, Croatia
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Abstract
Purpose of Review Axillary staging in the context of breast cancer is a contentious topic due to the varied practices across UK, Europe, and America. The ACOSOG Z0011 trial has questioned the role of axillary ultrasound in women with breast cancer. Published data has shown that women with ultrasound-positive lymph nodes have a worse prognosis than those with ultrasound-negative lymph nodes. Axillary ultrasound is limited as the sentinel lymph node (SLN) cannot be identified using B-mode ultrasound; however, with the advent of contrast-enhanced ultrasound (CEUS), this has now changed. Recent Findings The published literature has shown that the sentinel lymph node can be identified using CEUS. The rates are equivalent to blue dye alone but currently inferior to the dual technique of sentinel lymph node biopsy. There are several different contrast agents that can be used and the agents that remain in the sentinel lymph node for longer can identify areas of poor enhancement, allowing for targeted biopsy. Summary CEUS has the potential to revolutionize the way we manage the axilla in the future and may even replace surgical staging.
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Affiliation(s)
- Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street, Leeds, LS9 7TF UK.,University of Leeds, Leeds, LS2 9JT UK
| | - Karina Cox
- Department of Breast Surgery, Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ UK
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Dey A, Sinha RTK. Clinicopathological Correlation of Axillary Masses – Importance of Fine Needle Aspiration Cytology as a Diagnostic Modality. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2017. [DOI: 10.46347/jmsh.2017.v03i01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Paajanen H, Kilponen VM, Heikkinen J, Sammalkorpi H, Helle M. Feasibility of Axillary Ultrasound in the Quality Assessment of Sentinel Node Biopsy in Breast Cancer Surgery. Scand J Surg 2016; 95:195-8. [PMID: 17066617 DOI: 10.1177/145749690609500313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: The purpose of this study was to evaluate the efficacy of high-resolution axillary ultrasound (AU) in detecting the rate of recurrence after anegative sentinel node (SN) biopsy in patients with breast cancer and without additional axillary dissection. Materials and Methods: The operating oncologic surgeon performed 196 consequent sentinel node biopsies during surgery of breast cancer. The sentinel nodes were identified by using preoperative lymphoscintigraphy, intraoperative gamma probe and Patent Blue® dye. A routine postoperative follow-up of the patients were performed every 3rd month including clinical examinations, blood chemistry and mammography. After 31 months (range 14–49 months), a high-resolution AU was performed for 107 patients with a negative sentinel node during surgery and without axillary dissection, to visualize any abnormal lymph nodes in the axilla. If necessary, large core biopsies were undertaken to obtain histology of abnormal axillary nodes. Results: The SNs were visualized during preoperative lymphoscintigraphy in 167/196 (85%) and found during the surgery in 163/167 (98%) of patients. The mean number of removed SN were 1.7 ±0.8. The SN metastasis were found in 29% (56/196) of patients. During the follow-up, abnormal nodes were identified during AU in only 4/107 patients. Core biopsies confirmed benign histology in three patients and one case of lymphoma was detected. Conclusions: There were no axillary recurrences of breast cancer after a negative SN biopsy during the 2.6 year follow-up. Axillary ultrasound is a useful tool in the quality control of patients with negative SN biopsy and without diagnostic axillary dissection.
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Affiliation(s)
- H Paajanen
- Department of Surgery, Central Hospital of Mikkeli, Mikkeli, Finland.
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9
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Predictors for extensive nodal involvement in breast cancer patients with axillary lymph node metastases. Breast 2016; 27:175-81. [PMID: 27123958 DOI: 10.1016/j.breast.2016.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Various prediction models have been developed to predict the risk of having no additional axillary metastases in patients with a positive sentinel lymph node biopsy (SLNB), thereby disregarding patients with a positive ultrasound-guided lymph node biopsy (UGLNB). However, in the post-Z0011 trial era it is important to identify all patients with extensive nodal involvement for whom axillary treatment might still be beneficial. Therefore, the aim of this study is to identify factors predicting extensive nodal involvement (≥3 positive nodes) in the axilla, with the emphasis on the method of axillary staging: node positivity by UGLNB versus SLNB. METHODS All patients diagnosed with invasive breast cancer between January 2006 and December 2011 at the Máxima Medical Center were included. Univariate and multivariate logistic regression analyses were performed. RESULTS We included 302 cases, representing 301 node positive patients, of whom 177 cases had 1 or 2 positive lymph nodes and 125 cases had ≥3 positive lymph nodes. Multivariate analyses showed that a positive UGLNB (OR = 5.10; 95%CI = 2.78-9.36), lymphovascular invasion (OR = 3.60; 95%CI = 1.79-7.23) and a larger tumor size (OR = 1.03 per mm increase; 95%CI = 1.00-1.06) were significantly associated with extensive nodal involvement in patients with invasive breast cancer. CONCLUSION This study shows that a positive axilla, determined by UGLNB, is the most important factor for predicting further extensive nodal involvement. Hence, the role of axillary staging by ultrasound should be redefined since it might play an important role in selecting patients who may still benefit from axillary treatment.
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10
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Qiu SQ, Zeng HC, Zhang F, Chen C, Huang WH, Pleijhuis RG, Wu JD, van Dam GM, Zhang GJ. A nomogram to predict the probability of axillary lymph node metastasis in early breast cancer patients with positive axillary ultrasound. Sci Rep 2016; 6:21196. [PMID: 26875677 PMCID: PMC4753408 DOI: 10.1038/srep21196] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
Among patients with a preoperative positive axillary ultrasound, around 40% of them are pathologically proved to be free from axillary lymph node (ALN) metastasis. We aimed to develop and validate a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. Clinicopathological features of 322 early breast cancer patients with positive axillary ultrasound findings were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of ALN metastasis. A model was created from the logistic regression analysis, comprising lymph node transverse diameter, cortex thickness, hilum status, clinical tumour size, histological grade and estrogen receptor, and it was subsequently validated in another 234 patients. Coefficient of determination (R(2)) and the area under the ROC curve (AUC) were calculated to be 0.9375 and 0.864, showing good calibration and discrimination of the model, respectively. The false-negative rates of the model were 0% and 5.3% for the predicted probability cut-off points of 7.1% and 13.8%, respectively. This means that omission of axillary surgery may be safe for patients with a predictive probability of less than 13.8%. After further validation in clinical practice, this model may support increasingly limited surgical approaches to the axilla in breast cancer.
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Affiliation(s)
- Si-Qi Qiu
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Huan-Cheng Zeng
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Fan Zhang
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Cong Chen
- Department of Ultrasound Diagnosis, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Wen-He Huang
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Rick G. Pleijhuis
- Department of Internal Medicine, Medical Spectrum Twente, Enschede, The Netherlands
| | - Jun-Dong Wu
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Gooitzen M. van Dam
- Department of Surgery, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Guo-Jun Zhang
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Guangdong, China
- Cancer Research Center, Shantou University Medical College, Guangdong, China
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Moorman AM, Bourez RLJH, de Leeuw DM, Kouwenhoven EA. 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? ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2842-2848. [PMID: 26259889 DOI: 10.1016/j.ultrasmedbio.2015.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/02/2015] [Accepted: 06/16/2015] [Indexed: 06/04/2023]
Abstract
A non-invasive and widely available method for pre-operative evaluation of the axilla is axillary ultrasonography (US). The purpose of this study was to evaluate the diagnostic accuracy of axillary US and fine-needle aspiration cytology in a large cohort of breast cancer patients. The sensitivity and specificity of US and fine-needle aspiration cytology in our cohort of 1124 patients were 42.2% and 97.1%, respectively. As the number of axillary nodes increased, sensitivity increased. The percentage of false-negative US results was 18.9%; patients in this subgroup were significantly younger, had larger tumors, more often had lymph vascular invasion and were more likely to have estrogen receptor-positive tumors. Ultrasonography in combination with fine-needle aspiration cytology is useful in the pre-operative workup of breast cancer patients, especially patients with three or more nodal metastases. Special attention should be paid to younger women with larger tumors in whom a larger percentage of false-negative results are obtained.
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Affiliation(s)
- A M Moorman
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands.
| | - R L J H Bourez
- Department of Radiology, Hospital Group Twente, Almelo, The Netherlands
| | - D M de Leeuw
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
| | - E A Kouwenhoven
- Department of Surgery, Hospital Group Twente, Almelo, The Netherlands
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Verheuvel NC, van den Hoven I, Ooms HWA, Voogd AC, Roumen RMH. The Role of Ultrasound-Guided Lymph Node Biopsy in Axillary Staging of Invasive Breast Cancer in the Post-ACOSOG Z0011 Trial Era. Ann Surg Oncol 2014; 22:409-15. [DOI: 10.1245/s10434-014-4071-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Indexed: 12/12/2022]
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Accuracy of individual descriptors and grading of nodal involvement by axillary ultrasound in patients of breast cancer. Int J Breast Cancer 2014; 2013:930596. [PMID: 24455284 PMCID: PMC3880710 DOI: 10.1155/2013/930596] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/26/2013] [Accepted: 11/28/2013] [Indexed: 11/17/2022] Open
Abstract
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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Goodman S, O'Connor A, Kandil D, Khan A. The Ever-Changing Role of Sentinel Lymph Node Biopsy in the Management of Breast Cancer. Arch Pathol Lab Med 2014; 138:57-64. [DOI: 10.5858/arpa.2012-0441-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Axillary nodal status remains one of the most important prognostic indicators in the management of breast cancer. Axillary node metastases are seen in fewer than half of breast cancer cases, and axillary lymph node dissection is associated with significant morbidity. Sentinel lymph node biopsy (SLNB) has become the gold standard for axillary staging of breast cancer.
Objective.—To present a detailed review of the existing studies on SLNB in relation to the various techniques, the pathologic evaluation of the sentinel node, and special situations that can involve SLNB. We discuss recent trials that have already had an influence on surgical and pathologic management of breast cancer. In this article, we also discuss our practice and experience at UMass Memorial Medical Center, Worcester, Massachusetts, from a pathologic and surgical perspective.
Data Sources.—Published articles from peer-reviewed journals in PubMed (US National Library of Medicine).
Conclusions.—Sentinel node biopsy has become standard of care in the surgical management of breast cancer, and emerging data show that the survival benefits of axillary lymph node dissection may not be greater than sentinel node biopsy alone in patients with up to 2 positive sentinel nodes. Therefore, there have been recent changes to the role of intraoperative sentinel node evaluation, and an impact on overall breast cancer management.
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Affiliation(s)
- Steven Goodman
- From the Departments of Pathology (Drs Goodman, Kandil, and Khan) and Surgery (Dr O'Connor), University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
| | - Ashling O'Connor
- From the Departments of Pathology (Drs Goodman, Kandil, and Khan) and Surgery (Dr O'Connor), University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
| | - Dina Kandil
- From the Departments of Pathology (Drs Goodman, Kandil, and Khan) and Surgery (Dr O'Connor), University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
| | - Ashraf Khan
- From the Departments of Pathology (Drs Goodman, Kandil, and Khan) and Surgery (Dr O'Connor), University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
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Hwang SO, Lee SW, Kim HJ, Kim WW, Park HY, Jung JH. The Comparative Study of Ultrasonography, Contrast-Enhanced MRI, and (18)F-FDG PET/CT for Detecting Axillary Lymph Node Metastasis in T1 Breast Cancer. J Breast Cancer 2013; 16:315-21. [PMID: 24155761 PMCID: PMC3800728 DOI: 10.4048/jbc.2013.16.3.315] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/20/2013] [Indexed: 12/17/2022] Open
Abstract
Purpose A more noninvasive evaluation of axillary lymph node in breast cancer is one of the principal challenges of breast cancer treatment. To detect axillary lymph node metastasis (ALNM) in T1 breast cancer, we have compared the axillary ultrasonography (AUS), contrast-enhanced magnetic resonance imaging (cMRI), and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) to determine the most adequate test or a combination of tests. Methods Retrospectively, 349 T1 breast cancer patients who were preoperatively examined using AUS, cMRI, and PET/CT between 2008 and 2011 and whom underwent pathological evaluations of axillary lymph nodes were reviewed and analyzed. Results In total, 26.4% (92/349) of patients exhibited ALNM. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of AUS for determining ALNM were 44.6%, 88.7%, 58.6%, 81.7%, and 77.1%, respectively. cMRI was similar to AUS. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 44.5%, 94.2%, 73.2%, 82.6%, and 81.1%, respectively. The combination including cMRI and PET/CT was the most accurate with sensitivity, specificity, PPV, NPV, and accuracy values of 39.1%, 98.8%, 92.3%, 81.9%, and 83.1%, respectively. The mean number (3.5±4.2) of ALNMs in the patients who were positive based on cMRI and PET/CT and also pathologically proven to exhibit ALNM was significantly larger than the number (2.16±2.26) in other patients who exhibited ALNM (p=0.035). Conclusion There are no definitive modalities for detecting ALNM in T1 breast cancers to replace sentinel lymph node biopsy (SLNB). If ALNM is suspected based on cMRI and PET/CT, the axillary dissection without SLNB might be a better option because it is related to high possibilities of ALNM and large axillary metastatic volumes.
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Affiliation(s)
- Seung Ook Hwang
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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16
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Axillary ultrasound in patients with clinically node-negative breast cancer: which features are predictive of disease? J Surg Res 2013; 184:234-40. [DOI: 10.1016/j.jss.2013.03.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/17/2013] [Accepted: 03/20/2013] [Indexed: 02/05/2023]
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Utility of Preoperative Ultrasound for Predicting pN2 or Higher Stage Axillary Lymph Node Involvement in Patients With Newly Diagnosed Breast Cancer. AJR Am J Roentgenol 2013; 200:696-702. [DOI: 10.2214/ajr.12.9036] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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18
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Indications for Axillary Ultrasound Use in Breast Cancer Patients. Clin Breast Cancer 2012; 12:433-7. [DOI: 10.1016/j.clbc.2012.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 08/31/2012] [Accepted: 09/13/2012] [Indexed: 11/17/2022]
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19
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Güth U, Myrick ME, Viehl CT, Schmid SM, Obermann EC, Weber WP. The post ACOSOG Z0011 era: does our new understanding of breast cancer really change clinical practice? Eur J Surg Oncol 2012; 38:645-50. [PMID: 22608851 DOI: 10.1016/j.ejso.2012.04.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/03/2012] [Accepted: 04/29/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The ACOSOG Z0011 trial (Z0011) expanded our thinking about breast cancer (BC) and showed that limited metastatic disease left behind in the axilla did not compromise oncological safety in a selected group of patients. The aim of the current study was to assess the potential impact of Z0011 on clinical practice by testing the applicability of its criteria to a European patient population. METHODS We reviewed a consecutive series of 389 sentinel lymph node biopsies (SLNB) performed for invasive BC at the University Hospital Basel between 2003 and 2009 (65.6% of all surgically treated patients, n = 593). RESULTS When compared to the axillary lymph node dissection (ALND) arm of Z0011, our patients had significantly less advanced LN involvement (≥ 3 LN: 8.5% vs. 21.0%, p = 0.048). Thirty-five patients (9.0%) met the Z0011 inclusion criteria and had 1-2 SLNs with macrometastases (5.9% of all surgically treated BC patients). If the inclusion criteria of Z0011 had been applied, a considerable number of LNs would have been missed in two cases (0.5% of all SLNBs). CONCLUSIONS The application of the Z0011 led to the omission of completion ALND in less than 10% of all SLNB procedures (<6% of all surgically treated BC patients); therefore, we do not think that the perception of Z0011 as "practice changing" is justified. On the other side, skeptics of the routine implementation of the Z0011 protocol may overestimate its potential hazards. When performing a thorough preoperative clinical axillary staging, the number of patients who would have been undertreated is minimal.
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Affiliation(s)
- U Güth
- University Hospital Basel (UHB), Department of Gynecology and Obstetrics, Spitalstrasse 21, CH-4031 Basel, Switzerland.
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Rattay T, Muttalib M, Khalifa E, Duncan A, Parker SJ. Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy. Breast 2011; 21:210-4. [PMID: 21981897 DOI: 10.1016/j.breast.2011.09.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 09/13/2011] [Accepted: 09/18/2011] [Indexed: 11/15/2022] Open
Abstract
In patients with operable breast cancer, pre-operative evaluation of the axilla may be of use in the selection of appropriate axillary surgery. Pre-operative axillary ultrasound (US) and fine needle aspiration cytology (FNAC) assessments have become routine practice in many breast units, although the evidence base is still gathering. This study assessed the clinical utility of US+/-FNAC in patient selection for either axillary node clearance (ANC) or sentinel lymph node biopsy (SLNB) in patients undergoing surgery for operable breast cancer. Over a two-year period, 348 patients with a clinically negative axilla underwent axillary US. 67 patients with suspicious nodes on US also underwent FNAC. The sensitivity and specificity of axillary investigations to determine nodal involvement were 56% (confidence interval: 47-64%) and 90% (84-93%) for US alone, and 76% (61-87%) and 100% (65-100%) for FNAC combined with US, respectively. With a positive US, the post-test probability was 78%. A negative US carried a post-test probability of 25%. When FNAC was positive, the post-test probability was greater than unity. A negative FNAC yielded a post-test probability of 52%. All patients with positive FNAC and most patients with suspicious US were listed for axillary node clearance (ANC) after consideration at the multi-disciplinary team (MDT) meeting. With pre-operative axillary US+/-FNAC, 20% of patients were saved a potential second axillary procedure, facilitating a reduction in the overall re-operation rate to 12%. In this study, a positive pre-operative US+/-FNAC directs patients towards ANC. When the result is negative, other clinico-pathological factors need to be taken into account in the selection of the appropriate axillary procedure.
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Affiliation(s)
- T Rattay
- Breast Surgery, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
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21
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Devaraj S, Iqbal M, Donnelly J, Corder AP. Axillary ultrasound in invasive breast cancer: experience of our surgeons. Breast J 2011; 17:191-5. [PMID: 21410585 DOI: 10.1111/j.1524-4741.2010.01043.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Preoperative axillary ultrasound (USS) and fine needle aspiration cytology (FNAC) may allow diagnosis of axillary metastases and reduce repeat axillary procedures. This procedure is usually performed by radiologists. The aim of this prospective study was to evaluate the diagnostic accuracy of surgeon performed axillary USS and/or FNAC in determining axillary nodal status preoperatively. Patients with invasive breast cancer from August 2007 to July 2008 were studied prospectively. Patients who had primary hormonal therapy, neo-adjuvant therapy or distant metastases were excluded. Axillary USS was performed by two consultant breast surgeons trained in ultrasound and biopsy techniques. USS guided FNAC was used to evaluate suspicious nodes. Those with positive cytology (i.e., malignant cells) underwent axillary clearance and the remainder had either sentinel lymph node biopsy or axillary node sample. Axillary USS and FNAC results were compared with final axillary histology. One hundred and twenty eight patients were included with a mean age of 60 years. Nodes were nonpalpable in 96(75%) patients. Forty nine(38.2%) patients had axillary metastases on final histology and 30 of the 49(61%) were identified by preoperative USS guided FNAC. The sensitivity and specificity of this procedure were 61% and 100%, respectively. The positive predictive value and negative predictive value were 100% and 80.6%, respectively. Therefore, 61% of patients with axillary metastases were able to proceed directly to definitive axillary surgery. The use of USS and FNAC to evaluate and sample the axillary nodes in patients with invasive breast cancer can be a useful tool for the breast surgeon.
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Affiliation(s)
- Srinivasamurthy Devaraj
- Department of General Surgery, Hereford County Hospitals NHS Trust, Union walk, Hereford, UK
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22
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Neal CH, Daly CP, Nees AV, Helvie MA. Can Preoperative Axillary US Help Exclude N2 and N3 Metastatic Breast Cancer? Radiology 2010; 257:335-41. [DOI: 10.1148/radiol.10100296] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Nothacker M, Langer T, Weinbrenner S. [Diagnostic imaging in oncology--evidence reviews for evidence based guidelines by the Agency of Quality for Medicine (ÄZQ)]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2010; 104:554-562. [PMID: 21095608 DOI: 10.1016/j.zefq.2010.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/02/2010] [Accepted: 08/17/2010] [Indexed: 05/30/2023]
Abstract
Within the context of the development of evidence-based oncology guidelines, the Agency for Quality in Medicine undertook evidence reviews for diagnostic imaging procedures. Systematic searches retrieved no randomised controlled trials, but only cohort studies and case series of mostly moderate quality. The identified studies provided only a restricted basis for the guideline recommendations as their validity was limited and only outcomes of diagnostic accuracy were examined. However, decision criteria for recommending diagnostic strategies significantly comprise judgements about required resources and availability of diagnostic imaging procedures. These criteria as well as patient out-comes were mostly implicit and should be explicated in future. In order to increase the relevance of evidence reviews for oncological diagnosis, high quality studies which examine resources and patient-centred outcomes for diagnostic strategies are required.
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Hur SM, Kim SH, Lee SK, Kim WW, Choi JH, Kim S, Lee SJ, Choi JY, Choe JH, Kim JH, Kim JS, Nam SJ, Yang JH, Lee JE. The Preoperative Role of Breast-specific Gamma Imaging for the Breast Cancer Patients: In Comparison with Conventional Imaging Modality. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.2.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sung Mo Hur
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wan Wook Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyuck Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su-Jin Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Ho Choe
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Soo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok-Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Susini T, Nori J, Olivieri S, Molino C, Marini G, Bianchi S, Vezzosi V, Livi L, Mascalchi M, Scarselli G. Predicting the status of axillary lymph nodes in breast cancer: A multiparameter approach including axillary ultrasound scanning. Breast 2009; 18:103-8. [DOI: 10.1016/j.breast.2009.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 01/31/2009] [Accepted: 02/02/2009] [Indexed: 12/11/2022] Open
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Alkuwari E, Auger M. Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients. Cancer 2008; 114:89-93. [DOI: 10.1002/cncr.23344] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lanng C, Hoffmann J, Galatius H, Engel U. Assessment of clinical palpation of the axilla as a criterion for performing the sentinel node procedure in breast cancer. Eur J Surg Oncol 2007; 33:281-4. [PMID: 17084579 DOI: 10.1016/j.ejso.2006.09.032] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 09/28/2006] [Indexed: 11/30/2022] Open
Abstract
AIMS Clinically palpable lymph nodes (LNs) are regarded as a contraindication for performing the sentinel node (SN) procedure. Many studies have shown, however, that clinical assessment of axillary LNs is inaccurate. This study evaluated the reliability of clinical axillary LN assessment by experts and assessed whether inaccuracy can be related to LN size. METHODS Three hundred and one consecutive breast cancer patients undergoing either axillary dissection or SN were studied prospectively. RESULTS The risk of having metastasis to the LN was 40.4% if the preoperative clinical assessment was "non-palpable LN", 61.5% if the assessment was "palpable but benign LN" and 84.4% if it was "suspicious LN". There were no clinically significant differences in mean size either when the LN was palpable versus non-palpable, or when the LN had metastasis or not. CONCLUSIONS The clinical assessment of axillary LNs as a criterion for offering the SN procedure is of little value.
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Affiliation(s)
- C Lanng
- Breast Surgery Clinic, Horsholm Hospital, Usserod Kongevej 102, DK-2970 Horsholm, Denmark.
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28
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Nori J, Vanzi E, Bazzocchi M, Bufalini FN, Distante V, Branconi F, Susini T. Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy. Am J Surg 2007; 193:16-20. [PMID: 17188081 DOI: 10.1016/j.amjsurg.2006.02.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 02/20/2006] [Accepted: 02/20/2006] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sentinel node biopsy (SNB) is a time-consuming procedure that can be avoided in presence of axillary metastases. The aim of this study was to assess the accuracy of ultrasound scan (US) in the prediction of axillary nodes status in patients scheduled for SNB. METHODS Axillary US was performed and when feasible, a core biopsy of suspicious nodes was taken. The nodal status as assessed by US and/or core biopsy was compared with final histology. RESULTS Of the 132 patients enrolled, 31 (23.5%) had suspicious axillary nodes according to US; 19 (61.3%) were true positive, whereas 12 cases (38.7%) were not. In 14 of 31 suspicious cases an US-guided core-biopsy was taken, which in 11 of 14 cases (78.5%) confirmed the neoplastic involvement. Overall, core biopsy of the nodes correctly predicted the final histology in 13 of 14 cases (92.8%). CONCLUSIONS The US of axillary nodes, possibly associated with core biopsy, improved the preoperative evaluation of breast cancer patients scheduled for SNB.
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Affiliation(s)
- Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
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29
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Accuracy of ultrasonography and 99mTc-sestamibi scintimammography for assessing axillary lymph node status in breast cancer patients. A prospective study. Eur J Surg Oncol 2006; 32:933-6. [PMID: 16797155 DOI: 10.1016/j.ejso.2006.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 05/10/2006] [Indexed: 02/05/2023] Open
Abstract
AIMS The aim of this study was to evaluate the sensitivity, specificity and accuracy of axillary ultrasonography (US) and (99m)Tc-sestamibi scintimammography (SSM) in patients with breast cancer (BC) undergoing curative surgery. METHODS A series of 77 consecutive women (median age 54 years, range 36-70) with primary BC underwent both US and SSM from 2 to 15 (median 4) days prior to curative surgery. The results of imaging studies were compared against the final pathology. Breast-conserving surgery with axillary node (AN) dissection was performed in 49 (63.6%) patients, and modified radical mastectomy in 28 (36.4%) patients, according to the tumour staging. RESULTS Final pathology showed 5 pT1bN0, 1 pT1bN1, 28 pT1cN0, 19 pT1cN1, 7 pT2N0, and 17 pT2N1 BC. Overall, 719 AN were removed of which 106 (14.7%) were metastatized nodes (median 3, range 1-5 per patient). The sensitivity, specificity and accuracy were 67.6%, 80.0%, and 74.0% for US, 78.4%, 85.0%, and 81.8% for SSM, and 91.9%, 92.5%, and 92.2% for US and SSM together, respectively. There was a significant difference (p<0.05) in the number of metastatized AN between patients with metastases correctly detected and undetected by both US (3.1+/-1.3 vs. 2.0+/-0.7) and SSM (3.2+/-1.3 vs. 1.7+/-0.7). CONCLUSIONS Although the results of each diagnostic tests are strictly dependent on the number of the metastatized AN, the combination of axillary US and SSM is a sensitive low-cost procedure that should be suggested in all patients with BC, when a preoperative evaluation of the AN status is required.
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30
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Popli MB, Sahoo M, Mehrotra N, Choudhury M, Kumar A, Pathania OP, Thomas S. Preoperative ultrasound-guided fine-needle aspiration cytology for axillary staging in breast carcinoma. ACTA ACUST UNITED AC 2006; 50:122-6. [PMID: 16635029 DOI: 10.1111/j.1440-1673.2006.01545.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Axillary lymph node (ALN) status is considered to be the single most important prognostic indicator in patients with breast cancer. It can be assessed by various radiological, pathological and surgical techniques, the most accurate being histological examination of lymph nodes after axillary lymph node dissection (ALND). This prospective study was conducted to assess the feasibility and diagnostic accuracy of preoperative ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (USG-FNAC) of ALN in patients with breast cancer. Thirty patients with FNAC-proven breast cancer, planned for definitive surgery with axillary clearance, were included in this study. Ultrasonographic evaluation of the axillae of these patients was conducted for alterations in size, shape, contour and cortical morphology of lymph nodes that could reflect presence of underlying metastases. Ultrasound-guided fine-needle aspiration cytology of the ALN was done in 24 of these patients. These findings were evaluated, with the ALN status determined by histological examination after ALND. Out of the 30 patients, eight had T(1), 16 had T(2), five had T(3), and one had T(4) lesions. Ultrasound evaluation of the ALN had a sensitivity of 86.3%, a specificity of 41.6%, a positive predictive value of 79%, a negative predictive value of 50% and a diagnostic accuracy of 73.3%. Sensitivity of USG-FNAC was 78.95%, specificity was 100%, positive predictive value was 100%, negative predictive value was 55.56% and diagnostic accuracy was 83.33%. Our study concludes that preoperative USG-FNAC of ALN is a simple, minimally invasive, easily available and reliable technique for the initial determination of ALN status in patients with breast cancer. Those who are USG-FNAC positive can be directed towards ALND straight away, and only those who are USG-FNAC negative should be considered for sentinel lymph node biopsy. This will save considerable operating time, especially where facilities for sentinel lymph node biopsy (costly dye, gamma camera, nuclear medicine facilities) are restricted or not available.
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Affiliation(s)
- M B Popli
- Health Center, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
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31
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Mathijssen IMJ, Strijdhorst H, Kiestra SK, Wereldsma JCJ. Added value of ultrasound in screening the clinically negative axilla in breast cancer. J Surg Oncol 2006; 94:364-7. [PMID: 16967456 DOI: 10.1002/jso.20590] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND For staging purposes in breast cancer it is current practice to perform a sentinel node biopsy in a clinically negative axilla, followed by an axillary lymph node dissection if metastases are found in the sentinel node. To limit the number of surgical procedures it is therefore of importance to try and identify as much patients as possible who have axillary metastases. Clinical staging of the axillary nodes in breast cancer is mainly based on palpation, but ultrasound has been shown to be of additional value in detecting pathological nodes. METHODS In this paper, we report our results of screening 131 breast cancer patients without palpable axillary nodes through ultrasound. RESULTS Out of the 53 patients with axillary node involvement, 18 were identified as such by our radiologist, resulting in a detection score of 34%. DISCUSSION This high rate is probably reached because of the limited number of radiologists performing this procedure, thereby rapidly increasing their experience.
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Affiliation(s)
- I M J Mathijssen
- Department of General Surgery, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
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32
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Hwang SE, Moon WK, Cho N, Han W, Kim SW, Shin HJ, Hwang KT, Lee JE, Youn YK, Oh SK, Noh DY. Preoperative Evaluation of Lymph Node Metastasis with Using Ultrasonography for Examining the Axilla in Early Stage Breast Cancer. J Breast Cancer 2006. [DOI: 10.4048/jbc.2006.9.2.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sung Eun Hwang
- Depatrment of Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Jai Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Tae Hwang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yeo Kyu Youn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Keun Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Lumachi F, Brandes AA, Burelli P, Basso SMM, Iacobone M, Ermani M. Seroma prevention following axillary dissection in patients with breast cancer by using ultrasound scissors: a prospective clinical study. Eur J Surg Oncol 2004; 30:526-30. [PMID: 15135481 DOI: 10.1016/j.ejso.2004.03.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2004] [Indexed: 10/26/2022] Open
Abstract
AIMS Seroma formation following axillary dissection is a common complication of breast surgery. The aims of this study were (1) to analyse the risk factors of seroma formation, and (2) to evaluate the role of ultrasound scissors in performing axillary dissection in patients with primary breast cancer undergoing mastectomy and breast-conserving surgery. METHODS Ninety-two women (median age 55 years, range 33-73 years) requiring surgery for known unilateral primary breast cancer (pT1a=1, pT1b=20, pT1c=43, pT2=25, pT3=3) were prospectively randomised to undergo axillary dissection by either using (Group A, 45 patients) or not using (Group B, 47 patients) ultrasound scissors (US). Thirty-eight (41.3%) patients underwent modified radical mastectomy, while 54 (58.7%) underwent breast-conserving surgery. RESULTS Twenty-eight (30.4%) patients (Group A=9 out of 45, 20%; Group B=19 out of 47, 42%; P=NS) developed a wound seroma. Multivariate analysis using a logistic regression model showed that surgical procedure (RR=8.9; 95% CI: 3.2-25.3), total amount of drainage (RR=7.8; 95% CI: 2.8-22.0), and size of the tumour (RR=6.0; 95% CI: 2.2-16.5) independently correlated with seroma formation. The logistic regression function (RR=19.4; 95% CI: 6-62) correctly allocated 75 out of 92 (81.5%) patients. CONCLUSIONS Size of the tumour, and total amount of drainage represent the principal factors of seroma formation following axillary dissection in patients undergoing surgery for breast cancer. Although the use of ultrasound cutting devices may reduce the risk of seroma formation, further studies are need to verify the real impact on long-term morbidity of such technique.
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Affiliation(s)
- F Lumachi
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, School of Medicine, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
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