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The impact of preoperative axillary ultrasonography in T1 breast tumours

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Abstract

Objectives

To (a) determine the diagnostic validity of axillary ultrasound (AUS) in pT1 tumours and whether fine-needle aspiration (FNA) improves its diagnostic performance, and (b) determine the negative predictive value (NPV) of AUS in a simulation environment (cutoff: two lymph nodes with macrometastases) in patients fulfilling American College of Surgeons Oncology Group (ACOSOG) Z0011 criteria.

Materials and methods

This retrospective multicentre cross-sectional study analysed diagnostic accuracy in 355 pT1 breast cancers. All patients underwent AUS; visible nodes underwent FNA regardless of their AUS appearance. Sentinel node biopsy and axillary lymph node dissection (ALND) were gold standards. Data were analysed considering micrometastases ‘positive’ and considering micrometastases ‘N negative’. The simulation environment included all patients fulfilling ACOSOG Z0011 criteria.

Results

Axillary involvement: 22.8 %; AUS sensitivity: 46.9 % (Nmic positive)/66.7 % (Nmic negative); AUS+FNA sensitivity: 52.6 % (pNmic positive)/72.0 % (pNmic negative). In the simulation environment, AUS had 75.0 % sensitivity, 88.9 % specificity and 99.2 % NPV.

Conclusion

AUS has moderate sensitivity in T1 tumours. As ALND is unnecessary in micrometastases, considering micrometastases ‘N negative’ increases the practical impact of AUS.

In patients fulfilling ACOSOG Z0011 criteria, AUS alone can predict cases unlikely to benefit from ALND.

Key Points

• AUS+FNA can predict axillary involvement, thus avoiding SNB.

• Not all patients with axillary involvement need ALND.

• Axillary tumour load determines axillary management.

• AUS could classify patients according to axillary load.

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Fig. 1

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Abbreviations

ALND:

Axillary lymph node dissection

AUS:

Axillary ultrasound

BCS:

Breast-conserving surgery

FNA:

Fine-needle aspiration

PLN:

Palpable lymph node

SNB:

Sentinel node biopsy

WBRT:

Whole-breast radiotherapy

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Acknowledgments

Other members of the GMVOB include: L.Tortajada, MD; M. Villajos, MD; S. Ganau, MD; F. Escribano, MD; A. Martín, MD; E. Picas, MD; N. Martinez, MD; S. Santos, MD; I. Romero, MD; J. Planas, MD; J. de Torres, MD; A. Reñé, MD; P. Palañá, MD.

We thank Xavier Andreu, MD PhD, for his great help in writing up the pathology analysis and John Giba for help with English.

The scientific guarantor of this publication is Melcior Sentís, MD, Head of Department. Women’s Imaging. Department of Radiology. UDIAT Centre Diagnòstic. Institut Universitari Parc Taulí – UAB. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Marisa Baré, MD, PhD, epidemiologist at the Clinical Epidemiology Unit and Screening Office kindly provided statistical advice for this manuscript.

Each institution’s review board approved the study. Written informed consent was not required for this study because the data analyzed were collected as part of the routine protocols in force at each institution. Methodology: retrospective, diagnostic or prognostic study, multicentre study.

Author information

Authors and Affiliations

  1. Women’s Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Institut Universitari Parc Taulí – UAB, 1 Parc del Taulí, Sabadell, Barcelona, Spain

    Javier del Riego & Mariona Vilagran

  2. Breast Imaging, Department of Radiology, Althaia Xarxa Assistencial Universitària de Manresa, 1-3 Dr. Joan Soler St., Manresa, Barcelona, Spain

    María Jesús Diaz-Ruiz

  3. Breast Imaging, Department of Radiology, Consorci Sanitari de Terrassa, s/n Torrebonica Av., Terrassa, Barcelona, Spain

    Milagros Teixidó

  4. Breast Imaging, Department of Radiology, Consorci Hospitalari de Vic, Hospital General de Vic, 1 Francesc Pla “el vigata” St., Vic, Barcelona, Spain

    Judit Ribé

  5. Breast Imaging, Department of Radiology, Hospital General de Granollers, Hospital Universitari, Fundació Privada Hospital Asil de Granollers, s/n Francesc Ribas Av., Gronollers, Barcelona, Spain

    Mariona Vilagran

  6. Breast Imaging, Department of Radiology, Hospital Universitari Mútua Terrassa, 5, Doctor Robert Pl., Terrassa, Barcelona, Spain

    Lydia Canales

  7. Women’s Imaging Service, Department of Radiology, UDIAT Centre Diagnòstic, Institut Universitari Parc Taulí – UAB, 1 Parc del Taulí, Sabadell, Barcelona, Spain

    Melcior Sentís

Authors
  1. Javier del Riego
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  2. María Jesús Diaz-Ruiz
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Grup de Mama Vallès-Osona-Bages (GMVOB; Cooperative Breast Workgroup Vallés-Osona-Bagés)

Corresponding author

Correspondence to Javier del Riego.

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Fig. 2

Clinical management for the entire series (GIF 143 kb)

High resolution image (TIFF 1520 kb)

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del Riego, J., Diaz-Ruiz, M.J., Teixidó, M. et al. The impact of preoperative axillary ultrasonography in T1 breast tumours. Eur Radiol 26, 1073–1081 (2016). https://doi.org/10.1007/s00330-015-3901-2

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  • DOI: https://doi.org/10.1007/s00330-015-3901-2

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