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Bader W, Vogel-Minea CM, Blohmer JU, Duda V, Eichler C, Fallenberg E, Farrokh A, Golatta M, Gruber I, Hackelöer BJ, Heil J, Madjar H, Marzotko E, Merz E, Müller-Schimpfle M, Mundinger A, Ohlinger R, Peisker U, Schäfer FKW, Schulz-Wendtland R, Solbach C, Warm M, Watermann D, Wojcinski S, Hahn M. Best Practice Guideline - DEGUM Recommendations on Breast Ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:570-582. [PMID: 34921376 DOI: 10.1055/a-1634-5021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
For many years, breast ultrasound has been used in addition to mammography as an important method for clarifying breast findings. However, differences in the interpretation of findings continue to be problematic 1 2. These differences decrease the diagnostic accuracy of ultrasound after detection of a finding and complicate interdisciplinary communication and the comparison of scientific studies 3. In 1999, the American College of Radiology (ACR) created a working group (International Expert Working Group) that developed a classification system for ultrasound examinations based on the established BI-RADS classification of mammographic findings under consideration of literature data 4. Due to differences in content, the German Society for Ultrasound in Medicine (DEGUM) published its own BI-RADS-analogue criteria catalog in 2006 3. In addition to the persistence of differences in content, there is also an issue with formal licensing with the current 5th edition of the ACR BI-RADS catalog, even though the content is recognized by the DEGUM as another system for describing and documenting findings. The goal of the Best Practice Guideline of the Breast Ultrasound Working Group of the DEGUM is to provide colleagues specialized in senology with a current catalog of ultrasound criteria and assessment categories as well as best practice recommendations for the various ultrasound modalities.
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Affiliation(s)
- Werner Bader
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Germany
| | - Claudia Maria Vogel-Minea
- Brustzentrum, Diagnostische und Interventionelle Senologie, Rottal-Inn-Kliniken Eggenfelden, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Germany
| | - Volker Duda
- Senologische Diagnostik, Universitätsklinikum Gießen und Marburg, Germany
| | | | - Eva Fallenberg
- Brustzentrum, Diagnostische und Interventionelle Senologie, LMU Klinikum der Universität München Medizinische Klinik und Poliklinik IV, München, Germany
| | - André Farrokh
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Germany
| | - Michael Golatta
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Germany
| | - Ines Gruber
- Department für Frauengesundheit, Universitätsfrauenklinikum Tübingen, Germany
| | | | - Jörg Heil
- Sektion Senologie, Universitäts-Frauenklinik Heidelberg, Germany
| | - Helmut Madjar
- Gynäkologie und Senologie Wiesbaden, Praxis, Wiesbaden, Germany
| | - Ellen Marzotko
- Mammadiagnostik, Frauenheilkunde und Geburtshilfe, Praxis, Erfurt, Germany
| | - Eberhard Merz
- Ultraschall und Pränatalmedizin Frankfurt, Zentrum, Frankfurt/Main, Germany
| | - Markus Müller-Schimpfle
- DKG-Brustzentrum, Klinik für Radiologie, Neuroradiologie und Nuklearmedizin Frankfurt, Frankfurt am Main, Germany
| | - Alexander Mundinger
- Brustzentrum Osnabrück - Bildgebende und interventionelle Mamma Diagnostik, Franziskus Hospital Harderberg, Niels-Stensen-Kliniken, Georgsmarienhütte, Germany
| | - Ralf Ohlinger
- Interdisziplinäres Brustzentrum, Universitätsmedizin Greifswald, Klinik für Frauenheilkunde und Geburtshilfe, Greifswald, Germany
| | - Uwe Peisker
- BrustCentrum Aachen-Kreis Heinsberg, Hermann-Josef-Krankenhaus, Akademisches Lehrkrankenhaus der RWTH Aachen, Erkelenz, Germany
| | - Fritz K W Schäfer
- Bereich Mammadiagnostik und Interventionen, Universitätsklinikum Schleswig-Holstein Campus Kiel, Germany
| | | | - Christine Solbach
- Senologie, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Germany
| | - Mathias Warm
- Brustzentrum, Krankenhaus Holweide, Kliniken der Stadt Köln, Köln, Germany
| | - Dirk Watermann
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Freiburg, Germany
| | - Sebastian Wojcinski
- Zentrum für Frauenheilkunde, Brustzentrum, Universitätsklinikum OWL Bielefeld, Germany
| | - Markus Hahn
- Department für Frauengesundheit, Universitätsfrauenklinikum Tübingen, Germany
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da Costa Vieira RA, de Araujo Silva I, de Souza Coelho RD, de Almeida Junior CR, de Almeida Santos Yamashita ME. Brachial plexus schwannoma mimicking advanced breast carcinoma. Breast Dis 2021; 39:109-113. [PMID: 32083563 DOI: 10.3233/bd-190432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Schwannoma is an extremely rare benign tumour of the peripheral nervous system; its association with breast cancer is sporadic, and its association with the brachial plexus is extremely rare. CASE DESCRIPTION The authors report a case of a patient with breast cancer associated with nodulation in the left supraclavicular fossa, and due to the clinical and radiological features, it was considered metastatic lymph node disease. The patient underwent neoadjuvant chemotherapy, with partial response of the breast. Surgical treatment included resection of the supraclavicular nodule, which was found to be a supraclavicular fossa schwannoma. The correct diagnosis, influences the radiotherapeutic planning. The unusual presentation led to diagnostic confusion in the present case, a fact that changed the breast treatment. CONCLUSION The best of our knowledge it is the third description of brachial plexus schwannoma associated with breast cancer and the first with a synchronous association. The knowledge of this pathology and its potential to alter treatment justify the reporting of the present case.
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Affiliation(s)
| | - Igor de Araujo Silva
- Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, São Paulo, Brazil
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Liu D, Lan Y, Zhang L, Wu T, Cui H, Li Z, Sun P, Tian P, Tian J, Li X. Nomograms for Predicting Axillary Lymph Node Status Reconciled With Preoperative Breast Ultrasound Images. Front Oncol 2021; 11:567648. [PMID: 33898303 PMCID: PMC8058421 DOI: 10.3389/fonc.2021.567648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The axillary lymph node (ALN) status of breast cancer patients is an important prognostic indicator. The use of primary breast mass features for the prediction of ALN status is rare. Two nomograms based on preoperative ultrasound (US) images of breast tumors and ALNs were developed for the prediction of ALN status. Methods A total of 743 breast cancer cases collected from 2016 to 2019 at the Second Affiliated Hospital of Harbin Medical University were randomly divided into a training set (n = 523) and a test set (n = 220). A primary tumor feature model (PTFM) and ALN feature model (ALNFM) were separately generated based on tumor features alone, and a combination of features was used for the prediction of ALN status. Logistic regression analysis was used to construct the nomograms. A receiver operating characteristic curve was plotted to obtain the area under the curve (AUC) to evaluate accuracy, and bias-corrected AUC values and calibration curves were obtained by bootstrap resampling for internal and external verification. Decision curve analysis was applied to assess the clinical utility of the models. Results The AUCs of the PTFM were 0.69 and 0.67 for the training and test sets, respectively, and the bias-corrected AUCs of the PTFM were 0.67 and 0.67, respectively. Moreover, the AUCs of the ALNFM were 0.86 and 0.84, respectively, and the bias-corrected AUCs were 0.85 and 0.81, respectively. Compared with the PTFM, the ALNFM showed significantly improved prediction accuracy (p < 0.001). Both the calibration and decision curves of the ALNFM nomogram indicated greater accuracy and clinical practicality. When the US tumor size was ≤21.5 mm, the Spe was 0.96 and 0.92 in the training and test sets, respectively. When the US tumor size was greater than 21.5 mm, the Sen was 0.85 in the training set and 0.87 in the test set. Our further research showed that when the US tumor size was larger than 35 mm, the Sen was 0.90 in the training set and 0.93 in the test set. Conclusion The ALNFM could effectively predict ALN status based on US images especially for different US tumor size.
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Affiliation(s)
- Dongmei Liu
- Department of Ultrasound, The Second Affiliated Hospital, Harbin, China
| | - Yujia Lan
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Lei Zhang
- Department of Ultrasound, The Second Affiliated Hospital, Harbin, China
| | - Tong Wu
- Department of Ultrasound, The Second Affiliated Hospital, Harbin, China
| | - Hao Cui
- Department of Ultrasound, The Second Affiliated Hospital, Harbin, China
| | - Ziyao Li
- Department of Ultrasound, The Second Affiliated Hospital, Harbin, China
| | - Ping Sun
- Department of Ultrasound, The Second Affiliated Hospital, Harbin, China
| | - Peng Tian
- Department of Ultrasound, The Second Affiliated Hospital, Harbin, China
| | - Jiawei Tian
- Department of Ultrasound, The Second Affiliated Hospital, Harbin, China
| | - Xia Li
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
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de Oliveira-Junior I, Nahas EAP, Cherem AC, Nahas-Neto J, Vieira RADC. Sentinel Lymph Node Biopsy in T3 and T4b Breast Cancer Patients: Analysis in a Tertiary Cancer Hospital and Systematic Literature Review. Breast Care (Basel) 2021; 16:27-35. [PMID: 33716629 DOI: 10.1159/000504693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Breast cancer represents the most common type of cancer among women in the world. The presence and extent of axillary lymph node involvement represent an important prognostic factor. Sentinel lymph node biopsy (SLNB) is currently accepted for T1 and T2 with negative axillae (N0); however, many patients with T3-T4b tumors with N0 are often submitted to unnecessarily axillary lymph node dissection. Materials and Methods This is a retrospective, observational study of patients treated for breast cancer between 2008 and 2015, with T3/T4b tumors and N0, who underwent SLNB. A systematic review of the literature was also carried out in 5 bases. Results We analyzed 73 patients, and SLNB was negative for macrometastasis in 60.3% of the cases. With a mean follow-up of 45 months, no ipsilateral axillary local recurrence was observed. In the systematic review, only 7 articles presented data for analysis. Grouping these studies with the present series, the rate of N0 was 32.1% for T3 and 61.0% for T4b; grouping all studies (T3 and T4b n = 431) the rate was 32.5%. Conclusions SLNB in T3/T4b tumors is a feasible and safe procedure from the oncological point of view, as it has not been associated with ipsilateral axillary relapse.
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Affiliation(s)
- Idam de Oliveira-Junior
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Scholl of Medicine, UNESP, Botucatu, Brazil.,Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil
| | - Eliana Aguiar Petri Nahas
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Scholl of Medicine, UNESP, Botucatu, Brazil.,Department of Gynecology, Obstetrics and Mastology, Botucatu School of Medicine, UNESP, Botucatu, Brazil
| | | | - Jorge Nahas-Neto
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Scholl of Medicine, UNESP, Botucatu, Brazil.,Department of Gynecology, Obstetrics and Mastology, Botucatu School of Medicine, UNESP, Botucatu, Brazil
| | - René Aloisio da Costa Vieira
- Postgraduate Program of Gynecology, Obstetrics and Mastology, Botucatu Scholl of Medicine, UNESP, Botucatu, Brazil.,Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil.,Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil
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Analysis of the causes of false negative and false positive results of preoperative axillary ultrasound in patients with early breast cancer - a single-centre study. Contemp Oncol (Pozn) 2019; 22:247-251. [PMID: 30783389 PMCID: PMC6377422 DOI: 10.5114/wo.2018.82644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/30/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Properly planned and performed diagnostic tests allow the optimal treatment option to be chosen for the patient. They also allow qualification for the correct surgical procedure. Aim of the study In this study we evaluated the clinical value of preoperative ultrasound scan (USS) testing performed during primary disease staging in patients with early breast cancer qualified to sentinel lymph node biopsy (SLNB). Material and methods The group of breast cancer patients who underwent SLNB from March 2012 to May 2013. As well as the standard procedure of the preoperative diagnostics model, in each patient the USS of axillary lymph nodes was performed additionally. The results were compared with the data from postoperative pathological reports. We attempted to define the factors influencing the possibility of obtaining false positive and false negative USS results. Results The analysis comprised 172 patients. In 14.4% of cases with normal USS result the pathological result was different from the expected one (pN1). In 42.3% of patients with suspicious axillary lymph nodes the result of the pathological report was positive. The sensitivity of the USS testing was 89.3%, and the specificity was 34.4%, PPV – 85.6%, NPV – 42.3%. Conclusions Ultrasonographic assessment of axillary lymph nodes in breast cancer patients qualified for SLNB is a test with high sensitivity and high predictive value of the positive test result. The possibility of a result contrary to the actual nodal status may result primarily from the technical limitations of USS testing.
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Schässburger KU, Paepke S, Saracco A, Azavedo E, Ekström C, Wiksell H. High velocity pulse biopsy device enables controllable and precise needle insertion and high yield tissue acquisition. Phys Med 2018. [DOI: 10.1016/j.ejmp.2017.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Garganese G, Collarino A, Fragomeni S, Rufini V, Perotti G, Gentileschi S, Evangelista M, Ieria F, Zagaria L, Bove S, Giordano A, Scambia G. Groin sentinel node biopsy and 18F-FDG PET/CT-supported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: The GroSNaPET study. Eur J Surg Oncol 2017; 43:1776-1783. [DOI: 10.1016/j.ejso.2017.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 06/01/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022] Open
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Ceberio N, Cuadra M, Mendizabal JL, Gorostiaga J, Lete I. Should We Perform the Intraoperative Sentinel Lymph Node Biopsy in Breast Cancer? Clin Breast Cancer 2016; 16:e175-e180. [PMID: 27373841 DOI: 10.1016/j.clbc.2016.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/17/2016] [Accepted: 05/30/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the utility of performing a selective intraoperative sentinel lymph node biopsy (SLNB) in breast cancer patients. PATIENTS AND METHODS Patients in this prospective study were women with breast cancer seen at our hospital in 2014. These patients were divided into 2 groups on the basis of the clinical criteria age, tumor size, and molecular subtype: (1) Group A: women with clinical criteria indicative of the need to perform an intraoperative analysis of the sentinel lymph node (SLN); and (2) Group B: women in whom postoperative analysis of the SLN was performed. The final anatomopathologic findings obtained for the SLNs were analyzed and the sensitivity, specificity, positive predictive value, and negative predictive value of the clinical criteria used to decide between intraoperative or postoperative analysis of the SLN were estimated. RESULTS A total of 170 patients were included: 106 in group A and 64 in group B. The number of positive SLNs was 29 (22 in group A and 7 in group B; P = .09). The sensitivity of our clinical criteria for establishing the indication to perform an axillary SLNB was 75.86% (95% confidence interval [CI], 56.05%-88.98%), the specificity was 40.43% (95% CI, 32.35%-49.03%), the positive predictive value was 20.75% (95% CI, 13.73%-29.95%), and the negative predictive value was 89.06% (95% CI, 78.16%-95.12%). CONCLUSIONS The clinical findings used to decide whether or not to perform an SLNB exhibit low sensitivity and specificity and must therefore not be used to decide the need for an intraoperative SLNB.
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Affiliation(s)
- Nagore Ceberio
- Gynecologic Oncology Unit, Obstetrics and Gynecology Clinical Management Unit, Araba University Hospital Osakidetza, Basque Public Health Service, Vitoria, Spain
| | - María Cuadra
- Gynecologic Oncology Unit, Obstetrics and Gynecology Clinical Management Unit, Araba University Hospital Osakidetza, Basque Public Health Service, Vitoria, Spain
| | - José Luis Mendizabal
- Gynecologic Oncology Unit, Obstetrics and Gynecology Clinical Management Unit, Araba University Hospital Osakidetza, Basque Public Health Service, Vitoria, Spain
| | - Javier Gorostiaga
- Gynecologic Oncology Unit, Obstetrics and Gynecology Clinical Management Unit, Araba University Hospital Osakidetza, Basque Public Health Service, Vitoria, Spain
| | - Iñaki Lete
- Gynecologic Oncology Unit, Obstetrics and Gynecology Clinical Management Unit, Araba University Hospital Osakidetza, Basque Public Health Service, Vitoria, Spain.
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Hammon M, Dankerl P, Janka R, Wachter DL, Hartmann A, Schulz-Wendtland R, Uder M, Wenkel E. Fine needle aspiration cytology of lymph nodes in breast cancer follow-up is a feasible alternative to watchful waiting and to histology. BMC WOMENS HEALTH 2015; 15:114. [PMID: 26631071 PMCID: PMC4668692 DOI: 10.1186/s12905-015-0269-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/20/2015] [Indexed: 02/05/2023]
Abstract
Background Early detection of loco-regional breast cancer recurrence improves patients’ overall survival, as treatment can be initiated or active treatment can be changed. If a suspicious lymph node is diagnosed during a follow-up exam, surgical excision is often performed. The aim of this study was to evaluate the diagnostic performance of the minor invasive ultrasound-guided fine-needle aspiration cytology (FNAC) in sonomorphologically suspicious lymph nodes in breast cancer follow-up. Methods Between April 2010 and November 2012, we performed ultrasound-guided FNAC in 38 sonographically suspicious lymph nodes of 37 breast cancer follow-up patients. Cytological specimens were evaluated if the sample material was sufficient for diagnosis and if they contained cancer cells. Patients with negative cytology were followed up clinically and sonographically. To evaluate the diagnostic performance we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for physical examination, the different sonomorphological malignancy criteria and FNAC. Results In 36/38 (94.7 %) lymph nodes, the pathologist had enough material to establish a final diagnosis; in 2/38 (5.3 %) lymph nodes, the probe material was non-evaluable during cytology, these 2 were excluded from further statistical evaluation. Cytology revealed malignancy in 21 lymph nodes and showed no evidence for malignancy in 15 lymph nodes. There was no evidence for malignant disease in follow-up exams in the 15 cytologically benign lymph nodes with an average follow-up time of 3 years. The diagnostic performances of physical examination and FNAC were: Sensitivity 52/100 %, specificity 88/100 %, PPV 85/100 %, NPV 60/100 %, respectively. Conclusions Our preliminary results show that FNAC is a safe and fast diagnostic approach for the evaluation of suspicious lymph nodes in the follow-up of patients with breast cancer and, thus, together with follow-up represents a feasible alternative to surgery.
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Affiliation(s)
- Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Peter Dankerl
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Rolf Janka
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - David L Wachter
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany.
| | - Arndt Hartmann
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany.
| | - Rüdiger Schulz-Wendtland
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Evelyn Wenkel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
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Hyun S, Kim EK, Yoon J, Moon H, Kim M. Adding MRI to ultrasound and ultrasound-guided fine-needle aspiration reduces the false-negative rate of axillary lymph node metastasis diagnosis in breast cancer patients. Clin Radiol 2015; 70:716-22. [DOI: 10.1016/j.crad.2015.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 02/27/2015] [Accepted: 03/19/2015] [Indexed: 02/05/2023]
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Sohn YM, Hong IK, Han K. Role of [18F]fluorodeoxyglucose positron emission tomography-computed tomography, sonography, and sonographically guided fine-needle aspiration biopsy in the diagnosis of axillary lymph nodes in patients with breast cancer: comparison of diagnostic performance. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1013-1021. [PMID: 24866608 DOI: 10.7863/ultra.33.6.1013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this study was to compare the diagnostic performance of [(18)F]fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) with that of sonography and sonographically guided fine-needle aspiration (FNA) for determining the preoperative axillary lymph node (ALN) status and to evaluate the factors related to false-negative PET-CT, sonographic, and FNA results in ALN staging of invasive ductal carcinoma. METHODS From March 2009 to July 2012, 226 patients had a diagnosis of primary breast cancer. Among these patients, 107 constituted the study population after exclusion of transferred patients and patients with breast cancer other than invasive ductal carcinoma. The diagnostic performance of the modalities was compared with pathologic reports. Univariate and multivariate analyses were used to evaluate the relationship between clinicopathologic factors (symptoms, T stage, hormone receptors, and histologic grade), false-negative results, and true-negative results on PET-CT, sonography, and FNA. RESULTS Of the 107 patients, 45 (42.1%) had positive results on final pathologic analysis of ALNs. Sonographically guided FNA had a significantly higher specificity, positive predictive value, accuracy, and area under the receiver operating characteristic curve than sonography and PET-CT (P < .01). When sonography and PET-CT were combined, the sensitivity was significantly improved (P = .019) compared with sonography alone. When FNA and PET-CT were combined, the sensitivity and negative predictive value were significantly increased compared with each modality (P < .01). CONCLUSIONS Sonographically guided FNA was found to be an excellent diagnostic tool for preoperative evaluation of the ALN status. To obviate the step of sentinel lymph node biopsy for determining the ALN status, combined evaluation of ALNs by these modalities may be more complementary than the use of a single modality.
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Affiliation(s)
- Yu-Mee Sohn
- Departments of Radiology (Y.-M.S.) and Nuclear Medicine (I.K.H.), Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul Korea; and Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (K.H.).
| | - Il Ki Hong
- Departments of Radiology (Y.-M.S.) and Nuclear Medicine (I.K.H.), Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul Korea; and Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (K.H.)
| | - Kyunghwa Han
- Departments of Radiology (Y.-M.S.) and Nuclear Medicine (I.K.H.), Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul Korea; and Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (K.H.)
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de Gregorio N, Ebner F, Schwentner L, Friedl TW, Deniz M, Látó K, Kreienberg R, Janni W, Varga D. The role of preoperative ultrasound evaluation of inguinal lymph nodes in patients with vulvar malignancy. Gynecol Oncol 2013; 131:113-7. [DOI: 10.1016/j.ygyno.2013.07.103] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/27/2022]
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Abstract
The role of axillary surgery for the treatment of primary breast cancer is in a process of constant change. During the last decade, axillary dissection with removal of at least 10 lymph nodes (ALD) was replaced by sentinel lymph node biopsy (SLNB) as a staging procedure. Since then, the indication for SLNB rapidly expanded. Today's surgical strategies aim to minimize the rate of patients with a negative axillary status who undergo ALD. For some subgroups of patients, the indication for SLNB (e.g. multicentric disease, large tumors) or its implication for treatment planning (micrometastatic involvement, neoadjuvant chemotherapy) is being discussed. Although the indication for ALD is almost entirely restricted to patients with positive axillary lymph nodes today, the therapeutic effect of completion ALD is more and more questioned. On the other hand, the diagnostic value of ALD in node-positive patients is discussed. This article reflects today's standards in axillary surgery and discusses open issues on the diagnostic and therapeutic role of SLNB and ALD in the treatment of early breast cancer.
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Affiliation(s)
- Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Interdisziplinäres Brustzentrum am Klinikum Esslingen, Germany
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