Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer
<i>Background and objectives:</i> With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50−75% to 15−30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, a...
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MDPI AG
2020-03-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1010-660X/56/3/127 |
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| author | Dalia Rukanskienė Vincentas Veikutis Eglė Jonaitienė Milda Basevičiūtė Domantas Kunigiškis Renata Paukštaitienė Daiva Čepulienė Lina Poškienė Algirdas Boguševičius |
| author_facet | Dalia Rukanskienė Vincentas Veikutis Eglė Jonaitienė Milda Basevičiūtė Domantas Kunigiškis Renata Paukštaitienė Daiva Čepulienė Lina Poškienė Algirdas Boguševičius |
| author_sort | Dalia Rukanskienė |
| collection | DOAJ |
| description | <i>Background and objectives:</i> With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50−75% to 15−30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients’ and tumor characteristics leading to false-negative results. <i>Materials and Methods:</i> A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. <i>Results:</i> Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, <i>p</i> < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), <i>p</i> = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, <i>p</i> < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, <i>p</i> < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. <i>Conclusions:</i> Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients’ group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution. |
| first_indexed | 2024-03-12T09:37:09Z |
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| issn | 1010-660X |
| language | English |
| last_indexed | 2024-03-12T09:37:09Z |
| publishDate | 2020-03-01 |
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| spelling | doaj.art-72833b5f7a804ff8aba8d260f263c4302023-09-02T13:32:33ZengMDPI AGMedicina1010-660X2020-03-0156312710.3390/medicina56030127medicina56030127Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast CancerDalia Rukanskienė0Vincentas Veikutis1Eglė Jonaitienė2Milda Basevičiūtė3Domantas Kunigiškis4Renata Paukštaitienė5Daiva Čepulienė6Lina Poškienė7Algirdas Boguševičius8Department of Radiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaInstitute of Cardiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50162 Kaunas, LithuaniaDepartment of Radiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaFaculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, LithuaniaFaculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, LithuaniaDepartment of Physics, Mathematics and Biophysics, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, LithuaniaDepartment of Surgery, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaDepartment of Pathological Anatomy, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaDepartment of Surgery, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania<i>Background and objectives:</i> With improved diagnostic means of early breast cancer, the percentage of cases with metastasis in axillary lymph nodes has decreased from 50−75% to 15−30%. Lymphadenectomy and sentinel lymph node biopsy are not treatment procedures, as they aim at axillary nodal staging in breast cancer. Being surgical interventions, they can lead to various complications. Therefore, recently much attention has been paid to the identification of non-invasive methods for axillary nodal staging. In many countries, ultrasound is a first-line method to evaluate axillary lymph node status. The aim of this study was to evaluate the prognostic value of ultrasound in detecting intact axillary lymph nodes and to assess the accuracy of ultrasound in detecting a heavy nodal disease burden. The additional objective was to evaluate patients’ and tumor characteristics leading to false-negative results. <i>Materials and Methods:</i> A total of 227 women with newly diagnosed pT1 breast cancer were included to this prospective study conducted at the Breast Surgery Unit, Clinic of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, between May 1, 2016, and May 31, 2018. All patients underwent preoperative axillary ultrasound examination. Ultrasound data were compared with the results of histological examination. The accuracy and true-negative rate of ultrasound were calculated. The reasons of false-negative results were analyzed. <i>Results:</i> Of the 189 patients who had normally appearing axillary lymph nodes on preoperative ultrasound (PAUS-negative), 173 (91.5%) patients were also confirmed to have intact axillary lymph nodes (node-negative) by histological examination after surgery. The accuracy and the negative predictive value of ultrasound examination were 84.1% and 91.5%, respectively. In ≥3 node-positive cases, the accuracy and the negative predictive value increased to 88.7% and 98.3%, respectively. In total, false-negative results were found in 8.5% of the cases (n = 16); in the PAUS-negative group, false-negative results were recorded only in 1.6% of the cases (n = 3). The results of PAUS and pathological examination differed significantly between patients without and with lymphovascular invasion (LV0 vs. LV1, <i>p</i> < 0.001) as well as those showing no human epidermal growth factor receptor 2 (HER2) expression and patients with weakly or strongly expressed HER2 (HER2(0) vs. HER2(1), <i>p</i> = 0.024). Paired comparisons revealed that the true-negative rate was significantly different between the LV0 and LV1 groups (91% vs. 66.7%, <i>p</i> < 0.05), and the false-negative rate was statistically significant different between the HER2(0) and HER2(1) groups (10.5% vs. 1.2%, <i>p</i> < 0.05). Evaluation of other characteristics showed both the groups to be homogenous. <i>Conclusions:</i> Negative axillary ultrasound excluded axillary metastatic disease in 91.5% of the patients. PAUS had an accuracy of 88.7% in detecting a heavy nodal disease burden. With the absence of lymphovascular invasion (LV0), we can rely on PAUS examination that axillary lymph nodes are intact (PAUS-negative), and this patients’ group could avoid sentinel lymph node biopsy. Patients without HER2 expression are at a greater likelihood of false-negative results; therefore, the findings of ultrasound that axillary lymph nodes are intact (PAUS-negative results) should be interpreted with caution.https://www.mdpi.com/1010-660X/56/3/127breast canceraxillary lymph nodesultrasoundlymphadenectomysentinel lymph node biopsy |
| spellingShingle | Dalia Rukanskienė Vincentas Veikutis Eglė Jonaitienė Milda Basevičiūtė Domantas Kunigiškis Renata Paukštaitienė Daiva Čepulienė Lina Poškienė Algirdas Boguševičius Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer Medicina breast cancer axillary lymph nodes ultrasound lymphadenectomy sentinel lymph node biopsy |
| title | Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer |
| title_full | Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer |
| title_fullStr | Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer |
| title_full_unstemmed | Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer |
| title_short | Preoperative Axillary Ultrasound versus Sentinel Lymph Node Biopsy in Patients with Early Breast Cancer |
| title_sort | preoperative axillary ultrasound versus sentinel lymph node biopsy in patients with early breast cancer |
| topic | breast cancer axillary lymph nodes ultrasound lymphadenectomy sentinel lymph node biopsy |
| url | https://www.mdpi.com/1010-660X/56/3/127 |
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