Evaluation of axillary lymph node metastasis burden by preoperative ultrasound in early-stage breast cancer with needle biopsy-proven metastasis

  • X. Wang
  • L. Chen
  • Y. Sun
  • B. ZhangEmail author
Research Article
Part of the following topical collections:
  1. The Immune System and Cancer\Immunotherapy



The findings from the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial have questioned the use of axillary lymph node (ALN) dissection (ALND) in breast cancer patients with low ALN burden. In this study, our aim was to evaluate axillary nodal metastasis burden in patients with early-stage breast cancer who presented with metastatic lymph nodes diagnosed by fine needle aspiration biopsy (FNAB).


The data from 346 patients with cT1–T2 breast cancer who showed positive FNAB results and were seen at Tianjin Medical University Cancer Hospital from January 2014 to December 2017 were retrospectively analyzed. The patients were divided into high axillary nodal burden (≥ 3 positive lymph nodes) or low axillary nodal burden (one to two positive lymph nodes) groups. The clinical, radiological, and pathological features were compared between the two groups.


From the 346 patients, 136 (39.3%) had low axillary nodal burden and 210 patients had high axillary nodal burden. Compared to patients with high metastatic burden, the patients with low metastatic burden were more likely to have two or fewer abnormal lymph nodes detected by AUS (95.6% vs. 65.3%, p < 0.05), and more likely to have HR/HER2 lesions (15.4% vs. 5.2%, p < 0.05). Multivariate analysis revealed that patients with more than two abnormal lymph nodes had an odds ratio of 18.385 (95% CI 7.315–46.205, p < 0.05) to have axillary metastasis.


The presence of three or more abnormal lymph nodes on AUS was a significant indicator of high axillary nodal burden in early-stage breast cancer patients with positive FNAB findings. The combination of radiological and clinicopathological findings allows physicians to identify patients with high axillary nodal burden who will likely benefit from ALND in the post-ACOSOG Z0011 trial era.


Breast cancer Axillary nodal burden Axillary lymph node dissection Sentinel lymph node biopsy ROC curve 



Breast-conserving therapy


Axillary lymph node


Sentinel lymph node


Axillary lymph node dissection


Sentinel lymph node biopsy


Non-sentinel lymph node


Receiver-operator characteristic


Areas under the ROC curves


American College of Surgeons Oncology Group


American Joint Committee on Cancer


Estrogen receptor


Progesterone receptor


Human epidermal growth factor receptor-2


Axillary lymph node ultrasound




Fluorescence in situ hybridization


Chromosome 17 centromere locus




Positive predictive value


Negative predictive value


Odds ratio



The authors would like to acknowledge all the nurses in the breast cancer center for their services, along with the patients involved in this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. All authors have approved the final version of this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the author.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Key Laboratory of Cancer Prevention and Therapy, Tianjin, Key Laboratory of Breast Cancer Prevention and Therapy, The First Department of Breast Cancer, National Clinical Research Center for Cancer Tianjin’s Clinical Research Center for CancerTianjin Medical University Cancer Institute and HospitalTianjinChina

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