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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2014

01-10-2014 | Breast Oncology

Does BMI Affect the Accuracy of Preoperative Axillary Ultrasound in Breast Cancer Patients?

Authors: Anushi R. Shah, MD, Katrina N. Glazebrook, MD, Judy C. Boughey, MD, Tanya L. Hoskin, MS, Sejal S. Shah, MD, John R. Bergquist, MD, Sean C. Dupont, MD, Tina J. Hieken, MD

Published in: Annals of Surgical Oncology | Issue 10/2014

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Abstract

Introduction

Obesity affects 36 % of American women and is a well-documented breast cancer risk factor. Preoperative axillary ultrasound (AUS) is used routinely for axillary staging in newly diagnosed breast cancer patients; However, the impact of obesity on the usefulness of AUS is unknown. Our aim was to evaluate the effect of body mass index (BMI) on the performance of AUS.

Methods

From our prospective breast surgery database, we identified 1,510 consecutive invasive breast cancers in patients undergoing primary surgery, including axillary operation, from January 2010 to July 2013. Preoperative AUS was performed in 1,375 cases (91 %). We analyzed patient, pathology and imaging data.

Results

Median BMI was 27.4 and 479 patients (36 %) were classified as obese (BMI ≥ 30). Most tumors were T1 (71 %) and estrogen receptor-positive (87 %). AUS was suspicious in 401 (29 %) patients, of whom 374 had ultrasound-guided lymph node fine-needle aspiration (FNA). Overall, 124 patients (33.2 %) were FNA positive. FNA identified disease preoperatively in 35.8 % of node-positive obese patients. For all BMI categories (normal, overweight, obese), AUS was predictive of pathologic nodal status (p < 0.0001). AUS sensitivity did not differ across BMI categories, while specificity and accuracy were better for overweight (p = 0.001 and 0.008, respectively) and obese (p = 0.007 and 0.02, respectively) patients, than for normal-BMI patients.

Conclusions

Despite theoretical concern regarding both potential technical challenges and obesity-related lymph node alterations, the sensitivity of preoperative AUS for detecting nodal metastasis was similar in obese and non-obese patients, while specificity was better in obese patients. Preoperative AUS is valuable for preoperative nodal staging of obese breast cancer patients.
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Metadata
Title
Does BMI Affect the Accuracy of Preoperative Axillary Ultrasound in Breast Cancer Patients?
Authors
Anushi R. Shah, MD
Katrina N. Glazebrook, MD
Judy C. Boughey, MD
Tanya L. Hoskin, MS
Sejal S. Shah, MD
John R. Bergquist, MD
Sean C. Dupont, MD
Tina J. Hieken, MD
Publication date
01-10-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3902-4

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