Preoperative Sonographic Classification of Axillary Lymph Nodes in Patients With Breast Cancer: Node-to-Node Correlation With Surgical Histology and Sentinel Node Biopsy Results
- 1 December 2009
- journal article
- Published by American Roentgen Ray Society in American Journal of Roentgenology
- Vol. 193 (6), 1731-1737
- https://doi.org/10.2214/ajr.09.3122
Abstract
OBJECTIVE. The purpose of this study was to prospectively evaluate the role of axillary lymph node classification by sonography in breast cancer patients by node-to-node correlation with surgical histology and sentinel node biopsy results. SUBJECTS AND METHODS. Between June 2006 and December 2006, preoperative axillary sonography was performed in 191 consecutive breast cancer patients (median age, 46 years; age range, 24–79 years) who had been scheduled to undergo breast cancer surgery with sentinel node biopsy. The axillary lymph node that had the thickest cortex or that was closest to the primary tumor was prospectively classified and then removed through sonographically guided needle localization. Correspondence about and histologic results for the needle-localized nodes and the radioactive sentinel nodes were analyzed. The rate of malignancy, according to the sonographic classification, and the area under a receiver operating characteristic curve were analyzed. RESULTS. Of the 191 needle-localized nodes, 41 (21%) had metastases and 150 (79%) did not have metastases. When a cutoff point of a cortical thickness of 2.5 mm was used, sonographic classification showed 85% (35/41) sensitivity, 78% (117/150) specificity, and an area under the curve of 0.861 (95% CI, 0.796–0.926). Of the 54 patients with metastases at sentinel node biopsy or axillary lymph node dissection, 13 (24%) had false-negative results of sonographically guided needle localization. Unsuccessful lymphatic mapping because of absent radiotracer uptake during sentinel node biopsy was found in 4% (7/191), whereas all needle-localized nodes with a cortical thickness of more than 2.5 mm were confirmed as metastases. CONCLUSION. Sonographic classification of axillary lymph nodes is effective for predicting the presence of metastases to avoid sentinel node biopsy or to reduce unsuccessful lymphatic mapping during sentinel node biopsy.Keywords
This publication has 23 references indexed in Scilit:
- A Randomized Clinical Trial on Sentinel Lymph Node Biopsy Versus Axillary Lymph Node Dissection in Breast CancerAnnals of Surgery, 2008
- 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 randomised phase III trialThe Lancet Oncology, 2007
- Role of Sonography in the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic ReviewAmerican Journal of Roentgenology, 2006
- Ultrasonography and Fine-Needle Aspiration Cytology Can Spare Breast Cancer Patients Unnecessary Sentinel Lymph Node BiopsyAnnals of Surgical Oncology, 2006
- Lymphatic mapping and sentinel lymph node biopsy in early‐stage breast carcinomaCancer, 2005
- American Society of Clinical Oncology Guideline Recommendations for Sentinel Lymph Node Biopsy in Early-Stage Breast CancerJournal of Clinical Oncology, 2005
- Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy?Journal of the American College of Surgeons, 2005
- A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast CancerThe New England Journal of Medicine, 2003
- Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancerEuropean Journal of Cancer, 2003
- Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedureEuropean Journal of Cancer, 2003