Top

Published in:

01-02-2015 | Clinical Trial

Efficacy of physical examination, ultrasound, and ultrasound combined with fine-needle aspiration for axilla staging of primary breast cancer

Authors: Yu Feng, Rui Huang, Yingjian He, Aiping Lu, Zhaoqing Fan, Tie Fan, Meng Qi, Xinguang Wang, Wei Cao, Xing Wang, Yuntao Xie, Tianfeng Wang, Jinfeng Li, Tao Ouyang

Published in: Breast Cancer Research and Treatment | Issue 3/2015

Abstract

The aim of this study was to compare the efficacy of physical examination (PE), ultrasound (US), and US combined with fine-needle cytology (US-FNAC) in evaluation of node status before sentinel lymph node biopsy (SLNB) for breast cancer patients. We performed a retrospective study of 3,781 breast cancer patients and calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for PE, US, and US-FNAC, respectively. A total of 3,175 cases were documented as cN₀ and 606 as cN₁. Abnormal axillary nodes under US were detected in 1,152 cases, among which 821 were proven to have positive nodes by FNAC. The positive FNAC results enabled 11.7 % of cN₀ patients (373/3,175) to avoid unnecessary SLNB. All 331 cases with abnormal US but negative FNAC results, and the 2,629 cases with normal US underwent SLNB procedure for nodal staging, and metastatic nodes were identified in 745 patients. The sensitivity of PE was 32.2 %, with a specificity of 95.5 %, a PPV of 83.5 %, a NPV of 65 %, and an accuracy of 69.3 %. The sensitivity, specificity, PPV, NPV, and accuracy of axillary US alone were 58.6, 89.4, 79.6, 75.3, and 76.7 %, respectively. Combining axillary US with FNAC resulted in sensitivity, specificity, PPV, NPV, and accuracy of 52.4, 100, 100, 74.8, and 80.3 %, respectively. Our study demonstrated that US-FNAC is a feasible and effective triage during axillary staging for newly diagnosed breast cancer patients.

Available only for authorised users

Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Monypenny I et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst 98(9):599–609CrossRefPubMed

Sacre RA (1986) Clinical evaluation of axillar lymph nodes compared to surgical and pathological findings. Eur J Surg Oncol 12(2):169–173PubMed

Valente SA, Levine GM, Silverstein MJ, Rayhanabad JA, Weng-Grumley JG, Ji L, Holmes DR, Sposto R, Sener SF (2012) Accuracy of predicting axillary lymph node positivity by physical examination, mammography, ultrasonography, and magnetic resonance imaging. Ann Surg Oncol 19(6):1825–1830CrossRefPubMed

Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J (2006) Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. Am J Roentgenol 186(5):1342–1348CrossRef

Deurloo EE, Tanis PJ, Gilhuijs KG, Muller SH, Kroger R, Peterse JL, Rutgers EJ, Valdes Olmos R, Schultze Kool LJ (2003) Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer 39(8):1068–1073CrossRefPubMed

Damera A, Evans AJ, Cornford EJ, Wilson AR, Burrell HC, James JJ, Pinder SE, Ellis IO, Lee AH, Macmillan RD (2003) Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer. Br J Cancer 89(7):1310–1313CrossRefPubMedCentralPubMed

Ciatto S, Brancato B, Risso G, Ambrogetti D, Bulgaresi P, Maddau C, Turco P, Houssami N (2007) Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging. Breast Cancer Res Treat 103(1):85–91CrossRefPubMed

Genta F, Zanon E, Camanni M, Deltetto F, Drogo M, Gallo R, Gilardi C (2007) Cost/accuracy ratio analysis in breast cancer patients undergoing ultrasound-guided fine-needle aspiration cytology, sentinel node biopsy, and frozen section of node. World J Surg 31(6):1155–1163CrossRefPubMed

Sapino A, Cassoni P, Zanon E, Fraire F, Croce S, Coluccia C, Donadio M, Bussolati G (2003) Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer 88(5):702–706CrossRefPubMedCentralPubMed

10.

Krishnamurthy S, Sneige N, Bedi DG, Edieken BS, Fornage BD, Kuerer HM, Singletary SE, Hunt KK (2002) Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer 95(5):982–988CrossRefPubMed

11.

Wang XJ, Lin BH, Yang Z, Ouyang T, Li JF, Xu B, Zhang Y, Zhang MY (2006) Preliminary study on a new sentinel lymphoscintigraphy agent 99mTc-Rituximab for breast patient. Zhonghua Zhong Liu Za Zhi 28(3):200–203PubMed

12.

Li JF, Ouyang T, Wang XJ, Wang TF, Xie YT, Fan ZQ, Lin BH, Yang Z, Lin BY (2006) Preliminary study of new imaging agent, 99mTc-Rituximab, for sentinel lymph node biopsy of primary breast cancer. Zhonghua Wai Ke Za Zhi 44(9):600–602PubMed

13.

Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ, Cochran AJ, Cody HS 3rd, Edge SB, Galper S et al (2005) American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23(30):7703–7720CrossRefPubMed

14.

Wells B, Saskin R, Wright F, McCready D, Quan ML (2013) Measuring the quality of sentinel lymph node biopsy (SLNB) for breast cancer: a population-based evaluation. Ann Surg Oncol 20(2):615–619CrossRefPubMed

15.

Veronesi U, Viale G, Paganelli G, Zurrida S, Luini A, Galimberti V, Veronesi P, Intra M, Maisonneuve P, Zucca F et al (2010) Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg 251(4):595–600CrossRefPubMed

16.

Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, Ashikaga T, Weaver DL, Mamounas EP, Jalovec LM et al (2010) Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 11(10):927–933CrossRefPubMedCentralPubMed

17.

Majid S, Tengrup I, Manjer J (2013) Clinical assessment of axillary lymph nodes and tumor size in breast cancer compared with histopathological examination: a population-based analysis of 2,537 women. World J Surg 37(1):67–71CrossRefPubMed

18.

Pamilo M, Soiva M, Lavast EM (1989) Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients. J Ultrasound Med 8(3):115–120PubMed

19.

Lam WW, Yang WT, Chan YL, Stewart IE, Metreweli C, King W (1996) Detection of axillary lymph node metastases in breast carcinoma by technetium-99m sestamibi breast scintigraphy, ultrasound and conventional mammography. Eur J Nucl Med 23(5):498–503CrossRefPubMed

20.

Yang WT, Ahuja A, Tang A, Suen M, King W, Metreweli C (1996) High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med 15(3):241–246PubMed

21.

Yang WT, Metreweli C (1998) Colour Doppler flow in normal axillary lymph nodes. Br J Radiol 71(844):381–383CrossRefPubMed

22.

Bedrosian I, Bedi D, Kuerer HM, Fornage BD, Harker L, Ross MI, Ames FC, Krishnamurthy S, Edeiken-Monroe BS, Meric F et al (2003) Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol 10(9):1025–1030CrossRefPubMed

23.

Garcia Fernandez A, Fraile M, Gimenez N, Rene A, Torras M, Canales L, Torres J, Barco I, Gonzalez S, Veloso E et al (2011) Use of axillary ultrasound, ultrasound-fine needle aspiration biopsy and magnetic resonance imaging in the preoperative triage of breast cancer patients considered for sentinel node biopsy. Ultrasound Med Biol 37(1):16–22CrossRefPubMed

24.

Park SH, Kim MJ, Park BW, Moon HJ, Kwak JY, Kim EK (2011) Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol 18(3):738–744CrossRefPubMed

25.

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Maisonneuve P, Gatti G et al (2006) Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 7(12):983–990CrossRefPubMed

26.

Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 106(1):4–16CrossRefPubMed

27.

Leenders M, Richir M, Broeders M, Moormann G, Mollema R, Lopes Cardozo A, Meijer S, Schreurs H (2013) Axillary staging by ultrasound-guided fine-needle aspiration cytology in breast cancer patients. Still up to date? Breast J 19(6):637–642CrossRefPubMed

28.

Houssami N, Ciatto S, Turner RM, Cody HS 3rd (2011) Macaskill P: Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla. Ann Surg 254(2):243–251CrossRefPubMed

29.

Yuan XM, Wang N, Ouyang T, Yang L, Song MY, Lin BY, Xie YT, Li JF, Pan KF, You WC et al (2011) Current status of diagnosis and treatment of primary breast cancer in Beijing, 2008. Chin J Cancer Res 23(1):38–42CrossRefPubMedCentralPubMed

Title: Efficacy of physical examination, ultrasound, and ultrasound combined with fine-needle aspiration for axilla staging of primary breast cancer
Authors: Yu Feng
Rui Huang
Yingjian He
Aiping Lu
Zhaoqing Fan
Tie Fan
Meng Qi
Xinguang Wang
Wei Cao
Xing Wang
Yuntao Xie
Tianfeng Wang
Jinfeng Li
Tao Ouyang
Publication date: 01-02-2015
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2015
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-015-3280-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2015

Genomic predictor of residual risk of recurrence after adjuvant chemotherapy and endocrine therapy in high risk estrogen receptor-positive breast cancers

Bcl2 and Ki67 refine prognostication in luminal breast cancers

Differential expression of cancer-associated fibroblast-related proteins according to molecular subtype and stromal histology in breast cancer

Clinical outcomes in breast cancer patients with HIV/AIDS: a retrospective study

Germ line knockout of IGFBP-3 reveals influences of the gene on mammary gland neoplasia

DC-SCRIPT is a novel regulator of the tumor suppressor gene CDKN2B and induces cell cycle arrest in ERα-positive breast cancer cells

Keynote webinar | Spotlight on antibody–drug conjugates in cancer