Contrast-enhanced ultrasound -guided axillary lymph node core biopsy: Diagnostic accuracy in preoperative staging of invasive breast cancer.
OBJECTIVE
To evaluate accuracy of contrast enhanced ultrasound (CEUS)-sentinel procedure followed by core biopsy (CB) and marking in patients with breast cancer. To compare the axillary metastatic tumour burden in patients with positive vs. negative CB results.


METHODS
Two radiologists in our tertiary care hospital performed axillary CEUS sentinel procedures on consecutive US node negative breast cancer patients. The first enhancing lymph node (LN) was core biopsied and marked with a breast coil. The results were compared to final histopathology. We analysed the diagnostic performance of CEUS CB and its ability to detect patients with higher axillary burden (>2 metastasis).


RESULTS
During the study period between January 2013 and December 2014, altogether 54 patients (mean age 60.4 years) were included in the statistical analysis. The sensitivity for CEUS CB was 66.7%, specificity 100%, PPV 100%, NPV 93.8% and overall accuracy 94.4%. The method correctly recognised all the axillae with higher tumour burdens (sensitivity 100%, N=3) and 59.3% of coils marking the LNs were discovered.


CONCLUSIONS
CEUS -guided axillary CB proved to be feasible and accurate procedure with moderate sensitivity and it clearly identified the higher axillary tumour burden. The coil marking of LNs as used cannot be recommended. In clinical routine, CEUS procedure might be recommended in selective patient populations.
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, P.O. Box 100, Puijonlaaksontie 2, 70029 KYS, Finland; Cancer Center of Eastern Finland, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland. Electronic address: suvi.rautiainen@kuh.fi.
Suvi
S
Rautiainen
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, P.O. Box 100, Puijonlaaksontie 2, 70029 KYS, Finland. Electronic address: mazen.sudah@kuh.fi.
Mazen
M
Sudah
Department of Plastic Surgery, Kuopio University Hospital, Kuopio, P.O. Box 100, Puijonlaaksontie 2, 70029 KYS, Finland. Electronic address: sarianna.joukainen@kuh.fi.
Sarianna
S
Joukainen
Department of Clinical Pathology, Kuopio University Hospital, Kuopio, P.O. Box 100, Puijonlaaksontie 2, 70029 KYS, Finland; Unit of Pathology and Forensic Medicine at Institute of Clinical Medicine, Biocenter Kuopio, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland; Cancer Center of Eastern Finland, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland. Electronic address: reijo.sironen@kuh.fi.
Reijo
R
Sironen
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, P.O. Box 100, Puijonlaaksontie 2, 70029 KYS, Finland; Unit of Radiology, Biocenter Kuopio, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland; Cancer Center of Eastern Finland, University of Eastern Finland, P.O.B. 1627, FI-70211 Kuopio, Finland. Electronic address: ritva.vanninen@kuh.fi.
Ritva
R
Vanninen
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, P.O. Box 100, Puijonlaaksontie 2, 70029 KYS, Finland. Electronic address: anna.sutela@kuh.fi.
Anna
A
Sutela
D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology*; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D061705:Image-Guided Biopsy; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D016217:Ultrasonography, Mammary
D003287:Contrast Media
Axilla; Biopsy; Breast neoplasms; Contrast media; Ultrasonography