title: The accuracy of preoperative axillary nodal staging in primary breast cancer by ultrasound is modified by nodal metastatic load and tumor biology.
abstract: Background The outcome of axillary ultrasound (AUS) with fine-needle aspiration biopsy (FNAB) in the diagnostic work-up of primary breast cancer has an impact on therapy decisions. We hypothesize that the accuracy of AUS is modified by nodal metastatic burden and clinico-pathological characteristics. Material and methods The performance of AUS and AUS-guided FNAB for predicting nodal metastases was assessed in a prospective breast cancer cohort subjected for surgery during 2009-2012. Predictors of accuracy were included in multivariate analysis. Results AUS had a sensitivity of 23% and a specificity of 95%, while AUS-guided FNAB obtained 73% and 100%, respectively. AUS-FNAB exclusively detected macro-metastases (median four metastases) and identified patients with more extensive nodal metastatic burden in comparison with sentinel node biopsy. The accuracy of AUS was affected by metastatic size (OR 1.11), obesity (OR 2.46), histological grade (OR 4.43), and HER2-status (OR 3.66); metastatic size and histological grade were significant in the multivariate analysis. Conclusions The clinical utility of AUS in low-risk breast cancer deserves further evaluation as the accuracy decreased with a low nodal metastatic burden. The diagnostic performance is modified by tumor and clinical characteristics. Patients with nodal disease detected by AUS-FNAB represent a group for whom neoadjuvant therapy should be considered.
authors.affiliation: a Institution of Clinical Sciences Lund, Department of Surgery , Lund University, Skåne University Hospital , Lund , Sweden ;|b Hallands Sjukhus Halmstad , Halmstad , Sweden ;
authors.forename: Looket
authors.initials: L
authors.lastname: Dihge
authors.affiliation: c Institution of Clinical Sciences Lund, Department of Oncology and Pathology , Lund University , Lund , Sweden ;|d Department of Clinical Pathology , Laboratory Medicine Skåne , Lund , Sweden ;
authors.forename: Dorthe A
authors.initials: DA
authors.lastname: Grabau
authors.affiliation: e Unilabs Mammography Lund , Lund , Sweden ;
authors.forename: Rogvi W
authors.initials: RW
authors.lastname: Rasmussen
authors.affiliation: c Institution of Clinical Sciences Lund, Department of Oncology and Pathology , Lund University , Lund , Sweden ;
authors.forename: Pär-Ola
authors.initials: PO
authors.lastname: Bendahl
authors.affiliation: a Institution of Clinical Sciences Lund, Department of Surgery , Lund University, Skåne University Hospital , Lund , Sweden ;|f Department of Surgery and Urology , Skåne University Hospital , Malmö , Sweden.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rydén
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging / Q000473:pathology; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care; D047368:Tumor Burden; D014463:Ultrasonography; D055815:Young Adult