Ultrasound and ultrasound-guided fine needle aspiration biopsy can predict heavy nodal metastatic burden in early-stage breast cancer
Hye Shin Ahn1 , Sun Mi Kim2 , Mijung Jang2 , Bo La Yun2 , Eunyoung Kang3 , Eun-Kyu Kim3 , So Yeon Park4 , Bohyoung Kim5
1Department of Radiology, Chung-Ang University Hospital, , Chung-Ang University College of Medicine, Seoul, Korea
2Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do,, Korea
3Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Korea
4Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Korea
5Division of Biomedical Engineering, Hankuk University of Foreign Studies, Gyeonggi-do, Korea
Corresponding Author: Sun Mi Kim ,Tel: 031-787-7609, Fax: 031-787-4011, Email: kimsmlms@daum.net
Received: September 14, 2020;  Accepted: January 21, 2021.  Published online: January 21, 2021.
ABSTRACT
Purpose:
To predict heavy nodal burden (≥3 metastatic axillary lymph nodes [LNs]) using axillary ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) in patients with early-stage breast cancer.
Methods:
We retrospectively reviewed the medical records of 403 women (404 cancers) who underwent US-guided FNAB for axillary LN staging from January 2006 to December 2015. US findings and US-guided FNAB results were reviewed and compared using pathologic results as reference. Diagnostic performance was analyzed, and clinicopathologic and radiologic findings were compared between patients with <3 metastatic LNs and ≥3 metastatic LNs.
Results:
The final pathologic results revealed that 20.5% of cancers had heavy nodal metastases. US-guided FNAB showed significantly higher sensitivity (79.0% vs. 63.0%, p = 0.009) and specificity (84.8% vs. 79.3%, p = 0.036) in predicting heavy nodal metastases than did US. The presence of larger numbers of suspicious LNs (two or more) on axillary US and positive FNAB results were significantly correlated with heavy nodal burden in multivariate analysis. The odds ratios were 4.20 (95% CI: 1.90–9.39) for two suspicious LNs, 9.40 (95% CI: 2.99–29.54) for three or more suspicious LNs, and 14.22 (95% CI: 6.78–29.82) for positive FNAB results.
Conclusion:
The number of suspicious LNs detected on axillary US and FNAB results can help predict axillary heavy nodal burden in patients with early-stage breast cancer.
Keywords: Axillary lymph node; Early-stage breast cancer; Fine-needle aspiration biopsy; Ultrasonography
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