Abstract
Background
To predict the likelihood of ≥4 pathologically positive axillary nodes in breast cancer patients by computed tomography (CT) before neoadjuvant chemotherapy (NAC).
Methods
Inclusion criteria for the 97 patients reviewed were lymph nodes (LNs) pathologically proved positive with standard level I–II axillary dissection, contrast-enhanced CT was performed before surgery, contralateral breast cancer was not present, and NAC was not given before surgery. The size, number, and level of both ipsilateral and contralateral axillary LNs were studied by contrast-enhanced high-resolution CT for pathologically positive LNs in breast cancer patients.
Results
Level III LN was only detected in ipsilateral axilla of patients with ≥4 pathologically involved nodes. The number of ipsilateral level I–II LNs is the only factor significantly related to the pathological involvement of ≥4 axillary nodes. Increasing numbers of contralateral level I–II LNs are significantly related to increasing numbers of ipsilateral level I–II LNs. For the criterion of maximal LN size ≥5 mm, if contralateral level I–II LNs were negative and the cutoff points for ipsilateral level I–II LNs were 0–2 and ≥3, the sensitivity and specificity for ≥4 pathologically involved nodes would be 84.6 and 73.3%. If contralateral I–II LNs were positive, the negative predictive value was 80.0%.
Conclusion
Level III LN detection in ipsilateral axilla and the number of level I–II LNs in bilateral axilla will be helpful to predict ≥4 pathologically positive axillary nodes.
Similar content being viewed by others
References
Moore MP, Kinne DW. Axillary lymphadenectomy: a diagnostic and therapeutic procedure. J Surg Oncol. 1997;66:2–6.
Wilking N, Rutqvist LE, Carstensen J, Mattsson A, Skoog L. Prognostic significance of axillary nodal status in primary breast cancer in relation to the number of resected nodes. Stockholm breast cancer study group. Acta Oncol. 1992;31:29–35.
Katz A, Strom EA, Buchholz TA, Thames HD, Smith CD, Jhingran A, Hortobagyi G, Buzdar AU, Theriault R, Singletary SE, McNeese MD. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol. 2000;18:2817–27.
Taghian A, Jeong JH, Mamounas E, Anderson S, Bryant J, Deutsch M, Wolmark N. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five national surgical adjuvant breast and bowel project randomized clinical trials. J Clin Oncol. 2004;22:4247–54.
Bonadonna G, Valagussa P, Brambilla C, Ferrari L, Moliterni A, Terenziani M, Zambetti M. Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J Clin Oncol. 1998;16:93–100.
Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, Cruz AB Jr, Fisher ER, Wickerham DL, Wolmark N, DeCillis A, Hoehn JL, Lees AW, Dimitrov NV. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from national surgical adjuvant breast and bowel project B-18. J Clin Oncol. 1997;15:2483–93.
Reznik J, Cicchetti MG, Degaspe B, Fitzgerald TJ. Analysis of axillary coverage during tangential radiation therapy to the breast. Int J Radiat Oncol Biol Phys. 2005;61:163–8.
Britton PD, Goud A, Godward S, Barter S, Freeman A, Gaskarth M, Rajan P, Sinnatamby R, Slattery J, Provenzano E, O’Donovan M, Pinder S, Benson JR, Forouhi P, Wishart GC. Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer. Eur Radiol. 2009;19:561–9.
Ogasawara Y, Doihara H, Shiraiwa M, Ishihara S. Multidetector-row computed tomography for the preoperative evaluation of axillary nodal status in patients with breast cancer. Surg Today. 2008;38:104–8.
Shien T, Akashi-Tanaka S, Yoshida M, Hojo T, Iwamoto E, Miyakawa K, Kinoshita T. Evaluation of axillary status in patients with breast cancer using thin-section CT. Int J Clin Oncol. 2008;13:314–9.
Holwitt DM, Swatske ME, Gillanders WE, Monsees BS, Gao F, Aft RL, Eberlein TJ, Margenthaler JA. Scientific presentation award: the combination of axillary ultrasound and ultrasound-guided biopsy is an accurate predictor of axillary stage in clinically node-negative breast cancer patients. Am J Surg. 2008;196:477–82.
Uematsu T, Sano M, Homma K. In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: correlation of CT and histology. AJR Am J Roentgenol. 2001;176:1069–74.
Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD, Bassett RL Jr, Hunt KK. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol. 2008;191:646–52.
Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM. Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy—clinical experience in 100 patients. Radiology. 2009;250:41–9.
Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol. 2006;186:1342–8.
Ciatto S, Brancato B, Risso G, Ambrogetti D, Bulgaresi P, Maddau C, Turco P, Houssami N. Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging. Breast Cancer Res Treat. 2007;103:85–91.
Tahir M, Osman KA, Shabbir J, Rogers C, Suarez R, Reynolds T, Bucknall T. Preoperative axillary staging in breast cancer-saving time and resources. Breast J. 2008;14:369–71.
van Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ, Kroger R, Kroon BB. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 2006;13:31–5.
Fuster D, Duch J, Paredes P, Velasco M, Munoz M, Santamaria G, Fontanillas M, Pons F. Preoperative staging of large primary breast cancer with [18F]fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol. 2008;26:4746–51.
Heusner TA, Kuemmel S, Hahn S, Koeninger A, Otterbach F, Hamami ME, Kimmig KR, Forsting M, Bockisch A, Antoch G, Stahl A. Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients. Eur J Nucl Med Mol Imaging. 2009;36:1543–50.
Kim J, Lee J, Chang E, Kim S, Suh K, Sul J, Song I, Kim Y, Lee C. Selective sentinel node plus additional non-sentinel node biopsy based on an FDG-PET/CT scan in early breast cancer patients: single institutional experience. World J Surg. 2009;33:943–9.
Ueda S, Tsuda H, Asakawa H, Omata J, Fukatsu K, Kondo N, Kondo T, Hama Y, Tamura K, Ishida J, Abe Y, Mochizuki H. Utility of 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer. BMC Cancer. 2008;8:165.
Hodgson NC, Gulenchyn KY. Is there a role for positron emission tomography in breast cancer staging? J Clin Oncol. 2008;26:712–20.
Harada T, Tanigawa N, Matsuki M, Nohara T, Narabayashi I. Evaluation of lymph node metastases of breast cancer using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging. Eur J Radiol. 2007;63:401–7.
Memarsadeghi M, Riedl CC, Kaneider A, Galid A, Rudas M, Matzek W, Helbich TH. Axillary lymph node metastases in patients with breast carcinomas: assessment with nonenhanced versus USPIO-enhanced MR imaging. Radiology. 2006;241:367–77.
Swinson C, Ravichandran D, Nayagam M, Allen S. Ultrasound and fine needle aspiration cytology of the axilla in the pre-operative identification of axillary nodal involvement in breast cancer. Eur J Surg Oncol. 2009;35:1152–7.
Plewes DB, Dean PB. Detectability of spherical objects by computed tomography. Radiology. 1979;133:785–6.
Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, Kjaer M, Gadeberg CC, Mouridsen HT, Jensen MB, Zedeler K. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish breast cancer cooperative group 82b trial. N Engl J Med. 1997;337:949–55.
Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE, Wilson KS, Knowling MA, Coppin CM, Paradis M, Coldman AJ, Olivotto IA. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997;337:956–62.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ogino, I., Tayama, Y., Arai, M. et al. CT assessment of breast cancer for pathological involvement of four or more axillary nodes. Breast Cancer 19, 125–130 (2012). https://doi.org/10.1007/s12282-010-0216-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12282-010-0216-7