Assessment of Ultrasound Features Predicting Axillary Nodal Metastasis in Breast Cancer: The Impact of Cortical Thickness.
OBJECTIVE
To evaluate the accuracy of axillary ultrasound (AUS) in detecting nodal metastasis in patients with early-stage breast cancer and to identify AUS features with high predictive power.


METHODS
Prospective single-center preliminary study in 105 patients with a primary diagnosis of breast cancer and clinically negative axilla. AUS was performed using a 12 MHz linear-array transducer before ultrasound-guided needle biopsy. Nodal characteristics (shape, longitudinal-transverse [LT] axis ratio, margins, cortical thickness, hyperechoic hilum) were correlated with histopathological nodal status after SLNB or axillary lymph node dissection (ALND).


RESULTS
Nodal metastases were present in 42/105 patients (40.0%). Univariate analyses showed that absence of hyperechoic hilum, round shape, LT axis ratio<2, sharp margins and cortical thickness>3 mm were associated with lymph node metastasis. Multivariate logistic regression analysis revealed cortical thickness > 3 mm as an independent predictive parameter for nodal involvement. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 66.7, 74.6, 63.6, 77.0% and 71.4% respectively when cortical thickness > 3 mm was applied as the criterion for AUS positivity. Axillary tumor volume was low in patients with pT1/2 tumors and negative AUS, since only 3.2% of patients had > 2 metastatic lymph nodes.


CONCLUSIONS
Cortical thickness>3 mm is a reliable predictor of nodal metastatic involvement. Negative AUS does not exclude lymph node metastases, but extensive axillary tumor volume is rare.
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
A
A
Stachs
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
A Tra-Ha
AT
Thi
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
M
M
Dieterich
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
J
J
Stubert
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
S
S
Hartmann
Institute for Biostatistics, University of Rostock, Rostock, Germany.
Ä
Ä
Glass
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
T
T
Reimer
Department of Obstetrics and Gynecology, University of Rostock, Rostock, Germany.
B
B
Gerber
adenocarcinoma; axilla; breast; metastases; ultrasound
Ultraschall Med. 2012 Feb;33(1):33-59
21874631
Ann Surg Oncol. 2014 Oct;21(11):3369-71
24934586
Eur J Radiol. 2012 Oct;81(10 ):2576-84
22138121
AJR Am J Roentgenol. 2014 Dec;203(6):1371-8
25415717
Surgery. 2013 Oct;154(4):831-8; discussion 838-40
24074422
Cancer. 2014 Mar 15;120(6):885-93
24323615
Breast Cancer Res Treat. 2010 Aug;123(1):281-90
20140703
AJR Am J Roentgenol. 2010 Nov;195(5):1261-7
20966338
Eur Radiol. 2005 Jun;15(6):1215-23
15690206
J Magn Reson Imaging. 2009 Aug;30(2):309-12
19466713
Springerplus. 2013 Jul 29;2:350
23961414
J Clin Oncol. 2007 Aug 20;25(24):3670-9
17664461
JAMA Surg. 2015 Feb;150(2):137-43
25517573
Breast Care (Basel). 2014 May;9(2):87-95
24944550
Eur J Surg Oncol. 2007 May;33(4):409-19
17125963
Breast Cancer Res Treat. 2013 Jul;140(1):113-8
23813331
BMC Med Imaging. 2012 Dec 19;12 :35
23253859
JAMA. 2011 Feb 9;305(6):569-75
21304082
Breast. 2012 Oct;21(5):678-81
22835916
Ann Surg. 2010 Apr;251(4):595-600
20195151
Ann Surg Oncol. 2014 Oct;21(11):3440-7
24859939
Eur J Radiol. 2012 Nov;81(11):3154-9
22656671
Breast. 2009 Apr;18(2):119-22
19297159
Mol Clin Oncol. 2015 Mar;3(2):299-302
25798257
Ultrasound Med Biol. 2009 Aug;35(8):1249-56
19520493
Ann Surg Oncol. 2014 Sep;21(9):2904-10
24715214
AJR Am J Roentgenol. 2006 May;186(5):1342-8
16632729
Cancer. 1989 Jan 1;63(1):181-7
2910416
Lancet Oncol. 2010 Oct;11(10):927-33
20863759
Lancet Oncol. 2014 Nov;15(12):1303-10
25439688
AJR Am J Roentgenol. 2013 Mar;200(3):W314-20
23436877
Ann Surg Oncol. 2015 Feb;22(2):409-15
25205303
PLoS One. 2014 Sep 10;9(9):e106640
25207643
J Clin Oncol. 2006 Jan 20;24(3):337-44
16344321
Ann Surg. 2010 Sep;252(3):426-32; discussion 432-3
20739842
Ann Surg. 2012 Dec;256(6):920-4
23154393
Ann Surg. 2008 Feb;247(2):207-13
18216523
Ann Surg. 2011 Aug;254(2):243-51
21597359