Abstract
Background
Axillary lymph node status continues to be among the most important prognostic variables regarding breast cancer survival. We were interested in our ability to accurately predict axillary nodal involvement by using physical examination and standard breast imaging studies in combination.
Methods
A retrospective review was performed of 244 consecutive patients diagnosed with invasive breast carcinoma between May 2008 and December 2010 who underwent physical examination of the axilla, digital mammography, axillary ultrasonography, and contrast-enhanced breast magnetic resonance imaging and who had subsequent histopathologic evaluation of one or more axillary lymph nodes.
Results
A total of 62 (25%) of 244 women were found to have positive axillary lymph nodes on final histopathologic examination, 42% of whom were able to be identified preoperatively. The sensitivity for predicting axillary metastasis if any one or more examination modalities were suspicious was 56.5%. The specificity for predicting axillary metastasis if any three or more modalities were suspicious was 100%. Of the patients who had all four modalities negative, 14% were ultimately found to have histologically positive nodes at the time of surgery.
Conclusions
Physical examination and multimodal imaging in combination are useful for preoperative axillary staging and treatment planning. However, they remain inadequate definitive predictors of axillary lymph node involvement.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol. 1997;15:2345–50.
McMasters KM, Tuttle TM, Carlson D J, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol. 2000;18:2560–6.
Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546–53.
Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomized phase III trial. Lancet Oncol. 2007;8:881–8.
Crane-Okada R, Wascher RA, Elashoff D, Giuliano AE. Long-term morbidity of sentinel node biopsy versus complete axillary dissection for unilateral breast cancer. Ann Surg Oncol. 2008;15:1996–2005.
Purushotham AD, Upponi S, Klevesath MB, et al. Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol. 2005;23:4312–21.
Specht MC, Fey JV, Borgen PI, Cody HS. Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy? J Am Coll Surg. 2005;200:10–4.
Shetty MK, Carpenter WS. Sonographic evaluation of isolated abnormal axillary lymph nodes identified on mammograms. J Ultrasound Med. 2004;23:63–71.
Pamilo M, Soiva M, Lavast EM. Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients. J Ultrasound Med. 1989;8:115–20.
Nori J, Vanzi E, Bazzocchi M, et al. Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy. Am J Surg. 2007;193:16–20.
Lee MC, Eatrides J, Chau A, et al. Consequences of axillary ultrasound in patients with T2 or greater invasive breast cancers. Ann Surg Oncol. 2010;18:72–7.
March DE, Wechsler RJ, Kurtz AB, Rosenberg AL, Needleman L. CT-pathologic correlation of axillary lymph nodes in breast carcinoma. J Comput Assist Tomogr. 1991;15:440–4.
Peare R, Staff RT, Heys SD. The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2010;123:281–90.
Fernández AG, Fraile M, Giménez N, et al. Use of axillary ultrasound, ultrasound-fine needle aspiration biopsy and magnetic resonance imaging in the preoperative triage of breast cancer patients considered for sentinel node biopsy. Ultrasound Med. Biol. 2011;37:16–22.
Kvistad KA, Rydland J, Smethurst HB, Lundgren S, Fjosne HE, Haraldseth O. Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI. Eur Radiol. 2000;10:1464–71.
Yoshimura G, Sakurai T, Oura S, et al. Evaluation of axillary lymph node status in breast cancer with MRI. Breast Cancer. 1999;6:249–58.
Park SH, Kim MJ, Park BW, Moon HJ, Kwak JY, Kim EK. Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol. 2011;18:738–44.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. American Joint Commision on Cancer. Breast cancer: prespectives on anatomic staging—based on the AJCC staging manual, 7th ed. New York: Springer, 2010. p. 56.
Baruah BP, Goyal A, Young P, Douglas-Jones AG, Mansel RE. Axillary node staging by ultrasonography and fine-needle aspiration cytology in patients with breast cancer. Br J Surg. 2010;97:680–3.
Britton PD, Provenzano E, Barter S, et al. Ultrasound guided percutaneous axillary lymph node core biopsy: how often is the sentinel lymph node being biopsied? Breast. 2009;18:13–6.
Nathanson SD, Burke M, Slater R, Kapke A. Preoperative identification of the sentinel lymph node in breast cancer. Ann Surg Oncol. 2007;14:3102–10.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Valente, S.A., Levine, G.M., Silverstein, M.J. et al. Accuracy of Predicting Axillary Lymph Node Positivity by Physical Examination, Mammography, Ultrasonography, and Magnetic Resonance Imaging. Ann Surg Oncol 19, 1825–1830 (2012). https://doi.org/10.1245/s10434-011-2200-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-011-2200-7