Skip to main content

Advertisement

SpringerLink
Log in

Normal Axillary Ultrasound Excludes Heavy Nodal Disease Burden in Patients with Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Axillary lymph node stage is important in guiding adjuvant treatment for breast cancer. The role of axillary ultrasound (AUS) in axillary staging is uncertain.

Methods

From an institutional database, all newly diagnosed invasive breast carcinomas from February 1, 2011 to October 31, 2014 were identified; exclusions were for stage IV disease, palpable adenopathy, or receipt of neoadjuvant chemotherapy. AUS findings, categorized as suspicious versus not suspicious, were correlated with the number of nodal metastasis from surgical pathology. The false-negative rate of nonsuspicious AUS for identifying ≥3 lymph nodes positive on final pathology was calculated.

Results

A total of 513 cancers were included. Overall, 400 AUSs were not suspicious (78 %), and 113 were suspicious (22 %). The sensitivity and specificity of AUS for predicting ≥3 nodal metastasis were 71 and 83 %, respectively. The false-negative rate for detecting ≥3 nodal metastasis was 4 %. False-negative rate was higher for lobular versus nonlobular carcinomas (12.0 vs. 2.3 %, p = 0.004) and for pT2–pT4 tumors versus pT1 tumors (8.2 vs. 1.7 %, p = 0.005).

Conclusions

Patients with normal axillary physical exam and ultrasound rarely harbor a large nodal disease burden. Randomized trials of sentinel lymph node biopsy versus no axillary surgery in patients with normal AUS must be powered for subgroup analysis of patients with invasive lobular carcinoma and pT2–pT4 tumors. Preoperative identification of nodal metastasis may decrease the need for second surgeries and identify candidates for neoadjuvant chemotherapy. AUS is a noninvasive means of predicting disease burden preoperatively and as such is a powerful tool to individualize treatment plans.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Foster Jr. RS (1996) The biologic and clinical significant of lymphatic metastases in breast cancer. Surg Oncol Clin N Am. 5(1):79–104.

    PubMed  Google Scholar 

  2. McGuire WL. Prognostic factors for recurrence and survival in human breast cancer. Breast Cancer Res Treat. 1987;10(1):5–9.

    Article  CAS  PubMed  Google Scholar 

  3. 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(6):546–53.

    Article  PubMed  Google Scholar 

  4. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guidelines recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703–20.

    Article  PubMed  Google Scholar 

  5. Veronesi U, Viale G, Paganelli G, et al. Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg. 2010;251(4):595–600.

    Article  PubMed  Google Scholar 

  6. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75.

    Article  CAS  PubMed  Google Scholar 

  7. Gentilini O, Veronesi U. Abandoning sentinel lymph node biopsy in early breast cancer? A new trial in progress at the European Institute of Oncology in Milan (SOUND: sentinel node vs. observation after axillary ultrasound). Breast. 2012;21(5)678–81.

    Article  PubMed  Google Scholar 

  8. Cyr A, Gillanders W, Tucker N, et al. Axillary ultrasound with or without sentinel lymph node biopsy in detecting the spread of breast cancer in patients receiving breast conservation therapy. www.ClinicalTrials.gov identifier: NCT01821768. www.ClinicalTrials.gov. Accessed 14 March 2015.

  9. Fleiss JL. Statistical methods for rates and proportions, 2nd edn. New York: Wiley;1981.

    Google Scholar 

  10. Cools-Lartigue J, Sinclair A, Trabulsi N, Meguerditchian A, Mesurolle B, Fuhrer R, Meterissian S. Preoperative axillary ultrasound and fine-needle aspiration biopsy in the diagnosis of axillary metastases in patients with breast cancer: predictors of accuracy and future implications. Ann Surg Oncol. 2013; 20(3):819–27.

    Article  PubMed  Google Scholar 

  11. Schipper RJ, van Roozendaal LM, de Vries B, Pijnappel RM, Beets-Tan RG, Lobbes MB, Smidt ML. Axillary ultrasound for preoperative nodal staging in breast cancer patients: is it of added value? Breast. 2013;22(6):1108–13.

    Article  CAS  PubMed  Google Scholar 

  12. Abe H, Schacht D, Sennett CA, Newstead GM, Schmidt RA. Utility of preoperative ultrasound for predicting pN2 or higher stage axillary lymph node involvement in patients with newly diagnosed breast cancer. Am J Roentgenol. 2013;200(3):696–702.

    Article  Google Scholar 

  13. Choi JS, Kim MJ, Moon HJ, Kim EK, Yoon JH. False-negative results of preoperative axillary ultrasound in patients with invasive breast cancer: correlations with clinicopathologic findings. Ultrasound Med Biol. 2012;38(11):1881–6.

    Article  PubMed  Google Scholar 

  14. Johnson S, Brown S, Porter G, Steel J, Paisley K, Watkins R, Holgate C. Staging primary breast cancer. Are there tumour pathological features that correlate with a false-negative axillary ultrasound? Clin Radiol. 2011;66(6):497–9.

    Article  CAS  PubMed  Google Scholar 

  15. Meretoja TJ, Heikkila PS, Mansfield AS, et al. A predictive tool to estimate the risk of axillary metastases in breast cancer patients with negative axillary ultrasound. Ann Surg Oncol. 2014;21(7):2229–36.

    Article  CAS  PubMed  Google Scholar 

  16. Stachs A, Göde K, Hartmann S, et al. Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer: size of metastases as a limiting factor. SpringerPlus. 2013;2:350.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Boughey JC, Ballman KV, Hunt KK, et al. Axillary ultrasound after neoadjuvant chemotherapy and its impact on sentinel lymph node surgery: results from the American College of Surgeons Oncology Group Z1071 Trial (Alliance). J Clin Oncol. 2015; 33: Epub ahead of print.

  18. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) Clinical Trial. JAMA. 2013; 310(14):1455–61.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Boileau JF, Poirier B, Basik M, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2014; 33(3):258–64.

    Article  PubMed  Google Scholar 

  20. Caudle AS, Yang WT, Mittendorf EA, et al. Targeted axillary dissection improves axillary evaluation following neoadjuvant chemotherapy in node positive patients. In: Presented paper at: Society for Surgical Oncology 2015 Annual Conference; 27, March, 2015; Houston, TX. Available: http://vm.surgonc.org/common/media-player.aspx/6/27/201/1175?ContactGuid=e6191130-7ee1-499e-8a3c-caf40ff551dd. Accessed 11 April 2015.

  21. Kuehn T, Bauerfeind I, Fleige B, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicenter cohort study. Lancet Oncol. 2013;14(7):609–18.

    Article  PubMed  Google Scholar 

Download references

Disclosure

None.

Author information

Authors and Affiliations

  1. The Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA

    Rubie Sue Jackson MD, MPH, Charles Mylander PhD, Martin Rosman MD, Reema Andrade MBBS, Kristen Sawyer MS, Thomas Sanders PhD & Lorraine Tafra MD, FACS

Authors
  1. Rubie Sue Jackson MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles Mylander PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Rosman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Reema Andrade MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristen Sawyer MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Sanders PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lorraine Tafra MD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rubie Sue Jackson MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jackson, R.S., Mylander, C., Rosman, M. et al. Normal Axillary Ultrasound Excludes Heavy Nodal Disease Burden in Patients with Breast Cancer. Ann Surg Oncol 22, 3289–3295 (2015). https://doi.org/10.1245/s10434-015-4717-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4717-7

Keywords

Search

Navigation