title: A comparison of the diagnostic accuracy of magnetic resonance imaging to axillary ultrasound in the detection of axillary nodal metastases in newly diagnosed breast cancer.
abstract: Patients with a diagnosis of invasive breast cancer are increasingly undergoing breast magnetic resonance imaging (MRI) for preoperative staging including evaluation of axillary lymph node metastases (ALNM). This retrospective study aims to evaluate the utility of adding axillary ultrasound (AUS) in the preoperative setting when an MRI is planned or has already been performed. This IRB approved, HIPAA compliant study reviewed a total of 271 patients with a new diagnosis of invasive breast cancer at a single institution, between June 1, 2010 and June 30, 2013. The study included patients who received both AUS and MRI for preoperative staging. Data were divided into two cohorts, patients who underwent MRI prior to AUS and those who underwent AUS prior to MRI. AUS and MRI reports were categorized according to BI-RADS criteria as "suspicious" or "not suspicious" for ALNM. In the setting of a negative MRI and subsequent positive AUS, only one out of 25 cases (4%) were positive for metastases after correlating with histologic pathology. MRI detected metastatic disease in four out of 27 (15%) patients who had false-negative AUS performed prior to MRI. Our results indicate the addition of AUS after preoperative MRI does not contribute significantly to increased detection of missed disease. MRI could serve as the initial staging imaging method of the axilla in the setting that AUS is not initially performed and may be valuable in identification of lymph nodes not identified on AUS.
authors.affiliation: USF Health Department of Radiology, Tampa, FL, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Assing
authors.affiliation: Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Bhavika K
authors.initials: BK
authors.lastname: Patel
authors.affiliation: USF Health Department of Radiology, Tampa, FL, USA.
authors.forename: Neel
authors.initials: N
authors.lastname: Karamsadkar
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Weinfurtner
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Usmani
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: John V
authors.initials: JV
authors.lastname: Kiluk
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Drukteinis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D014463:Ultrasonography
keywords: MRI; breast cancer; lymph nodes; metastasis; ultrasound