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BMC Cancer
Published in: BMC Cancer 1/2024

Open Access 01-12-2024 | Breast Cancer | Research

Diagnostic value of applying preoperative breast ultrasound and clinicopathologic features to predict axillary lymph node burden in early invasive breast cancer: a study of 1247 patients

Authors: Hua Shao, Yixin Sun, Ziyue Na, Hui Jing, Bo Li, Qiucheng Wang, Cui Zhang, Wen Cheng

Published in: BMC Cancer | Issue 1/2024

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Abstract

Background

Since the Z0011 trial, the assessment of axillary lymph node status has been redirected from the previous assessment of the occurrence of lymph node metastasis alone to the assessment of the degree of lymph node loading. Our aim was to apply preoperative breast ultrasound and clinicopathological features to predict the diagnostic value of axillary lymph node load in early invasive breast cancer.

Methods

The 1247 lesions were divided into a high lymph node burden group and a limited lymph node burden group according to axillary lymph node status. Univariate and multifactorial analyses were used to predict the differences in clinicopathological characteristics and breast ultrasound characteristics between the two groups with high and limited lymph node burden. Pathological findings were used as the gold standard.

Results

Univariate analysis showed significant differences in ki-67, maximum diameter (MD), lesion distance from the nipple, lesion distance from the skin, MS, and some characteristic ultrasound features (P < 0.05). In multifactorial analysis, the ultrasound features of breast tumors that were associated with a high lymph node burden at the axilla included MD (odds ratio [OR], 1.043; P < 0.001), shape (OR, 2.422; P = 0.0018), hyperechoic halo (OR, 2.546; P < 0.001), shadowing in posterior features (OR, 2.155; P = 0.007), and suspicious lymph nodes on axillary ultrasound (OR, 1.418; P = 0.031). The five risk factors were used to build the predictive model, and it achieved an area under the receiver operating characteristic (ROC) curve (AUC) of 0.702.

Conclusion

Breast ultrasound features and clinicopathological features are better predictors of high lymph node burden in early invasive breast cancer, and this prediction helps to develop more effective treatment plans.
Literature
1.
Morrow M, Van Zee KJ, Patil S, Petruolo O, Mamtani A, Barrio AV, et al. Axillary dissection and nodal irradiation can be avoided for most node-positive Z0011-eligible breast cancers: a prospective validation study of 793 patients. Ann Surg. 2017;266(3):457–62.PubMedCrossRef
2.
Kramer R. 26th Annual San Antonio Breast Cancer Symposium, San Antonio, Texas, USA, 3–6 December 2003: update on clinical research. Breast Cancer Res. 2004;6(2):84–7.
3.
Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, 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.PubMedCrossRef
4.
Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst. 2006;98(9):599–609.PubMedCrossRef
5.
King TA, Morrow M. Surgical issues in patients with breast cancer receiving neoadjuvant chemotherapy. Nat Rev Clin Oncol. 2015;12(6):335–43.PubMedCrossRef
6.
Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, et al. NCCN guidelines insights: breast Cancer, Version 1.2017. J Natl Compr Canc Netw. 2017;15(4):433–51.PubMedCrossRef
7.
Li JW, Tong YY, Jiang YZ, Shui XJ, Shi ZT, Chang C. Clinicopathologic and Ultrasound variables Associated with a heavy axillary nodal tumor burden in invasive breast carcinoma. J Ultrasound Med. 2019;38(7):1747–55.PubMedCrossRef
8.
Yang WT, Ahuja A, Tang A, Suen M, King W, Metreweli C. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med. 1996;15(3):241–6.PubMedCrossRef
9.
de Boer M, van Deurzen CH, van Dijck JA, Borm GF, van Diest PJ, Adang EM, et al. Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med. 2009;361(7):653–63.PubMedCrossRef
10.
Akissue de Camargo Teixeira P, Chala LF, Shimizu C, Filassi JR, Maesaka JY, de Barros N. Axillary Lymph Node Sonographic features and breast tumor characteristics as predictors of malignancy: a Nomogram to predict risk. Ultrasound Med Biol. 2017;43(9):1837–45.PubMedCrossRef
11.
Zhang J, Li X, Huang R, Feng WL, Kong YN, Xu F, et al. A nomogram to predict the probability of axillary lymph node metastasis in female patients with breast cancer in China: a nationwide, multicenter, 10-year epidemiological study. Oncotarget. 2017;8(21):35311–25.PubMedCrossRef
12.
Qiu SQ, Zeng HC, Zhang F, Chen C, Huang WH, Pleijhuis RG, et al. A nomogram to predict the probability of axillary lymph node metastasis in early breast cancer patients with positive axillary ultrasound. Sci Rep. 2016;6:21196.PubMedPubMedCentralCrossRef
13.
Nowikiewicz T, Nowak A, Wiśniewska M, Wiśniewski M, Zegarski W. Diagnostic value of preoperative axillary lymph node ultrasound assessment in patients with breast cancer qualified for sentinel lymph node biopsy. Wideochirurgia i inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques. 2015;10(2):170–7.PubMedPubMedCentralCrossRef
14.
Ecanow JS, Abe H, Newstead GM, Ecanow DB, Jeske JM. Axillary staging of breast cancer: what the radiologist should know. Radiographics. 2013;33(6):1589–612.PubMedCrossRef
15.
Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thurlimann B, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast Cancer 2013. Ann Oncol. 2013;24(9):2206–23.PubMedPubMedCentralCrossRef
16.
Nowikiewicz T, Nowak A, Wiśniewska M, Wiśniewski M, Nowikiewicz M, Zegarski W. Analysis of the causes of false negative and false positive results of preoperative axillary ultrasound in patients with early breast cancer - a single-centre study. Contemp Oncol (Poznan Poland). 2018;22(4):247–51.
17.
Bevilacqua JL, Kattan MW, Fey JV, Cody HS 3rd, Borgen PI, Van Zee KJ. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol. 2007;25(24):3670–9.
18.
Greer LT, Rosman M, Charles Mylander W, Liang W, Buras RR, Chagpar AB, et al. A prediction model for the presence of axillary lymph node involvement in women with invasive breast cancer: a focus on older women. Breast J. 2014;20(2):147–53.PubMedCrossRef
19.
Zhu AQ, Li XL, An LW, Guo LH, Fu HJ, Sun LP, et al. Predicting Axillary Lymph Node Metastasis in patients with breast invasive Ductal Carcinoma with negative Axillary Ultrasound results using conventional ultrasound and contrast-enhanced Ultrasound. J Ultrasound Med. 2020;39(10):2059–70.PubMedCrossRef
20.
Hong AS, Rosen EL, Soo MS, Baker JA. BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 2005;184(4):1260–5.PubMedCrossRef
21.
22.
Gardner ID, Bowern NA, Blanden RV. Cell-medicated cytotoxicity against Ectromelia virus-infected target cells. III. Role of the H-2 gene complex. Eur J Immunol. 1975;5(2):122–7.PubMedCrossRef
23.
Suami H, Pan WR, Taylor GI. Historical review of breast lymphatic studies. Clin Anat. 2009;22(5):531–6.PubMedCrossRef
24.
Borgstein PJ, Meijer S, Pijpers RJ, van Diest PJ. Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past and the periareolar blue method. Ann Surg. 2000;232(1):81–9.PubMedPubMedCentralCrossRef
25.
Matsubara N, Mukai H, Itoh K, Nagai S. Prognostic impact of Ki-67 overexpression in subgroups categorized according to St. Gallen with early stage breast cancer. Oncology. 2011;81(5–6):345–52.PubMedCrossRef
26.
Chung MJ, Lee JH, Kim SH, Suh YJ, Choi HJ. Simple prediction model of Axillary Lymph Node Positivity after analyzing Molecular and clinical factors in early breast Cancer. Med (Baltim). 2016;95(20):e3689.CrossRef
27.
Rauch GM, Kuerer HM, Scoggins ME, Fox PS, Benveniste AP, Park YM, et al. Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status. Breast Cancer Res Treat. 2013;139(3):639–47.PubMedPubMedCentralCrossRef
28.
Chao TC, Lo YF, Chen SC, Chen MF. Prospective sonographic study of 3093 breast tumors. J Ultrasound Med. 1999;18(5):363–70. quiz 71–2.PubMedCrossRef
29.
Leucht WJ, Rabe DR, Humbert KD. Diagnostic value of different interpretative criteria in real-time sonography of the breast. Ultrasound Med Biol. 1988;14(Suppl 1):59–73.PubMedCrossRef
30.
Celebi F, Pilanci KN, Ordu C, Agacayak F, Alco G, Ilgun S, et al. The role of ultrasonographic findings to predict molecular subtype, histologic grade, and hormone receptor status of breast cancer. Diagn Interv Radiol. 2015;21(6):448–53.PubMedPubMedCentralCrossRef
31.
Cole-Beuglet C, Soriano RZ, Kurtz AB, Goldberg BB. Ultrasound analysis of 104 primary breast carcinomas classified according to histopathologic type. Radiology. 1983;147(1):191–6.PubMedCrossRef
32.
Barsky SH, Rao CN, Grotendorst GR, Liotta LA. Increased content of type V Collagen in desmoplasia of human breast carcinoma. Am J Pathol. 1982;108(3):276–83.PubMedPubMedCentral
33.
Hashimoto H, Suzuki M, Oshida M, Nagashima T, Yagata H, Shishikura T, et al. Quantitative ultrasound as a predictor of node metastases and prognosis in patients with breast cancer. Breast Cancer. 2000;7(3):241–6.PubMedCrossRef
34.
Wu W, Cheng S, Deng H, Wu J, Mao K, Cao M. Impact of breast Cancer subtype defined by immunohistochemistry hormone receptor and HER2 status on the incidence of Immediate Postmastectomy Reconstruction. Med (Baltim). 2016;95(3):e2547.CrossRef
35.
Jin X, Jiang YZ, Chen S, Shao ZM, Di GH. A Nomogram for Predicting the pathological response of Axillary Lymph Node Metastasis in breast Cancer patients. Sci Rep. 2016;6:32585.PubMedPubMedCentralCrossRef
36.
Murata T, Watase C, Shiino S, Jimbo K, Iwamoto E, Yoshida M, et al. Development and validation of a preoperative Scoring System to Distinguish between Nonadvanced and Advanced Axillary Lymph Node Metastasis in patients with early-stage breast Cancer. Clin Breast Cancer. 2021;21(4):e302–e11.PubMedCrossRef
37.
Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD, et al. 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(3):646–52.PubMedCrossRef
38.
Tateishi T, Machi J, Feleppa EJ, Oishi R, Furumoto N, McCarthy LJ, et al. In vitro B-mode ultrasonographic criteria for diagnosing axillary lymph node metastasis of breast cancer. J Ultrasound Med. 1999;18(5):349–56.PubMedCrossRef
39.
Caudle AS, Kuerer HM, Le-Petross HT, Yang W, Yi M, Bedrosian I, et al. Predicting the extent of nodal disease in early-stage breast cancer. Ann Surg Oncol. 2014;21(11):3440–7.PubMedCrossRef
40.
Jackson RS, Mylander C, Rosman M, Andrade R, Sawyer K, Sanders T, et al. Normal Axillary Ultrasound excludes heavy nodal Disease Burden in patients with breast Cancer. Ann Surg Oncol. 2015;22(10):3289–95.PubMedCrossRef
41.
Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel Lymph Node Biopsy for patients with early-stage breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017;35(5):561–4.PubMedCrossRef
42.
Chen Y, Xie Y, Li B, Shao H, Na Z, Wang Q, et al. Automated breast ultrasound (ABUS)-based radiomics nomogram: an individualized tool for predicting axillary lymph node tumor burden in patients with early breast cancer. BMC Cancer. 2023;23(1):340.PubMedPubMedCentralCrossRef
43.
Xiong J, Zuo W, Wu Y, Wang X, Li W, Wang Q, et al. Ultrasonography and clinicopathological features of breast cancer in predicting axillary lymph node metastases. BMC Cancer. 2022;22(1):1155.PubMedPubMedCentralCrossRef
44.
Yao J, Zhou W, Xu S, Jia X, Zhou J, Chen X et al. Machine learning-based breast Tumor Ultrasound Radiomics for pre-operative prediction of Axillary Sentinel Lymph Node Metastasis Burden in early-stage invasive breast Cancer. Ultrasound Med Biol. 2023.
45.
Zhang H, Sui X, Zhou S, Hu L, Huang X. Correlation of conventional ultrasound characteristics of breast tumors with Axillary Lymph Node Metastasis and Ki-67 expression in patients with breast Cancer. J Ultrasound Med. 2019;38(7):1833–40.PubMedCrossRef
Metadata
Title
Diagnostic value of applying preoperative breast ultrasound and clinicopathologic features to predict axillary lymph node burden in early invasive breast cancer: a study of 1247 patients
Authors
Hua Shao
Yixin Sun
Ziyue Na
Hui Jing
Bo Li
Qiucheng Wang
Cui Zhang
Wen Cheng
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2024
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-024-11853-2

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