Correlation of clinical examination and ultrasonogram with histopathology in predicting the metastatic axillary lymph nodes in breast cancer

Authors

  • Jacob Rony Department of General Surgery, Amala Institute of Medical Sciences, Amala Nagar, Thrissur 680 555, Kerala, India
  • Marar Krishnakumar Department of General Surgery, Amala Institute of Medical Sciences, Amala Nagar, Thrissur 680 555, Kerala, India
  • Moothedathparambil Ramakrishnan Babu Department of General Surgery, Amala Institute of Medical Sciences, Amala Nagar, Thrissur 680 555, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20160214

Keywords:

Breast cancer, Ultrasonogram, Axillary lymph node, Fatty hilum, Lymphatic drainage, Elastography

Abstract

Background: Examination of breast and axilla is an integral part of triple assessment of patient with suspected carcinoma breast. A retrospective study was conducted to compare the axillary lymph nodes in carcinoma breast based on clinical, ultrasonogram (USG) and post-operative histopathology (HPR).

Methods: One hundred patients with early breast cancer were included in the study. Clinical examination of axilla, followed by USG examination of all patients was done preoperatively. This was compared with the post-operative HPR of axillary lymph nodes (gold standard). The validity of the findings was evaluated by using sensitivity and specificity.

Results: There is a strong positive correlation for the detection of total number of lymph nodes (r=0.935) between USG and HPR which is statistically significant (p <0.05).  The correlation between clinical detection and HPR detection of axillary lymph nodes was weak (r= 0.278). Accuracy of the USG findings was good (81%) compared to the HPR findings and this was statistically significant (p <0.05). The USG morphologic lymph node features with the greatest correlation with malignancy were loss of central fatty hilum (r= 0.953) and cortical thickness (r= 0.914). In HPR and USG, the number of positive lymph nodes was high in stage II.

Conclusions: The sensitivity for detecting malignancy by USG is only average. USG is more likely to detect an abnormal node if there is morphologic features of increased cortical thickening and loss of central fatty hilum. A multidisciplinary effort is needed to reduce unnecessary axillary dissections.

References

Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer. 2013;132:1133-45.

www.icmr.nic.in . Annual ICMR. Indian Council of Medical Research. 2004-2005.

R de Freitas, Costa MV, Schneider SV, Marussi E. Accuracy of ultrasound and clinical examination in the diagnosis of axillary lymph node metastasis in breast cancer. Eur J Surg Oncol. 1991;17:240-4.

Van Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ. Ultrasonography and fine needle aspiration cytology can spare breast cancer payients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 2006;13:31-5.

Davis JK, Brill YM, Simmons S, Sachleben BC, Cibull ML, McGrath P. Ultrasound guided fine needle aspiration of clinically negative lymph nodes versus sentinel node mapping in patients at high risk for axillary metastasis. Ann Surg Oncol. 2006;13:1545-52.

Sousa MYT, Illescas MEB, Rodriguez MLR. Preoperative staging of axillary lymph nodes in breast cancer: ultrasonographic parameters and ultrasound guided core needle biopsy. Radiologia. 2011;53:544-51.

Tytgat J, Verbanck J, Vandewiele I, deWinter H. Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: a prospective study in 144 patients. J Clin Ultrasound. 1997;25:53-6.

Oz A, Demirkazik FB, Akpinar MG. Efficiency of ultrasound and ultrasound guided fine needle aspiration cytology in preoperative assessment of axillary lymph node metastasis in breast cancer. J Breast Cancer. 2012;15:211-7.

Altinyolla H, Dingil G, Berberoglu U. Detection of infraclavicular lymph node metastasis using ultrasonography in breast cancer. J Surg Oncol. 2005;92:299-303.

Bonnema J, van Geel AN, Ooijen B. Ultrasound guided aspiration biopsy for detection of onopalpable axillary node metastasis in breast cancer patients: new diagnostic method. World J Surg. 1997;21:270-4.

Oruwari JUN, Chung MA, Koelliker S, Steinhoff MM, Cady B. Axillary staging using ultrasound guided FNAC in locally advanced breast cancer. Am J Surg. 2002;184:307-9.

Sapino A, Cassoni P, Zanon E. Ultrasonographically guided FNAC of axillary lymph nodes: role in breast cancer management. Br J Cancer. 2003;88:702-6.

Damera A, Evans AJ, Cornford EJ. Diagnosis of axillary nodal metastasis by USG guided core biopsy in operable breast cancer. Br J Cancer. 2003;89:1310-3.

Shetty MK, Carpenter WS. Sonographic evaluation of isolated abnormal axillary lymph nodes identified on mammograms. J Ultrasound Med. 2004;23:63-71.

Ying L, Hou Y, Zheng HM, Lin X. Real time elastography for the differentiation of benign and malignant superficial lymph node: a meta-analysis. Eur J Radiol. 2012;81:2576-84.

Sever AR, Millis P, Jones SE. Preoperative sentinal node identification with ultrasound using microbubbles in patients with breast cancer. Am J Radiol. 2001;196:251-6.

Bhatia KS, Tong CS, Yuen EH, Ahuja AT. Shear wave elasticity imaging of cervical lymph nodes. Ultrasound Med Biol. 2012;38:195-201.

Downloads

Published

2016-12-13

Issue

Section

Original Research Articles