Number of Axillary Lymph Node Metastases Determined by Preoperative Ultrasound is Related to Prognosis in Patients with Breast Cancer

Yuko Kijima, Heiji Yoshinaka, Munetsugu Hirata, Tadao Mizoguchi, Sumiya Ishigami, Akihiro Nakajo, Hideo Arima, Shinichi Ueno, Shoji Natsugoe, Yuko Kijima, Heiji Yoshinaka, Munetsugu Hirata, Tadao Mizoguchi, Sumiya Ishigami, Akihiro Nakajo, Hideo Arima, Shinichi Ueno, Shoji Natsugoe

Abstract

Objective: To analyze the impact on prognosis of the number of axillary lymph node metastases (LNM) detected by ultrasound (US) in patients with breast cancer.

Methods: One-to-one comparison of LNM was performed between the ultrasound and histologic diagnosis in 380 patients.

Results: The accuracy of preoperative ultrasound diagnosis was 79.7%. According to the subdivision of number of LNM (0, 1-3, 4-9, 10+), the accuracy rates associated with LNM were 82%, 49%, 34%, and 86%, respectively. The disease-free-survival curves according to the number of LNM were similar in them.

Conclusion: Preoperative ultrasound can determine axillary involvement and may be useful for predicting prognosis.

Figures

Figure 1
Figure 1
.Correlation of the number of lymph node metastases between ultrasound diagnosis and histologic diagnosis. A significant difference using multiple logistic analysis was found (P

Figure 2

Five-year disease-free survival curves according…

Figure 2

Five-year disease-free survival curves according to the number of lymph node metastases by…

Figure 2
Five-year disease-free survival curves according to the number of lymph node metastases by ultrasonography.

Figure 3

Five-year disease-free survival curves according…

Figure 3

Five-year disease-free survival curves according to the number of lymph node metastases by…

Figure 3
Five-year disease-free survival curves according to the number of lymph node metastases by histologic examination.

Figure 4

Ultrasonographic appearance of a normal…

Figure 4

Ultrasonographic appearance of a normal lymph node (type 1). This lymph node (arrow)…

Figure 4
Ultrasonographic appearance of a normal lymph node (type 1). This lymph node (arrow) shows thin C-shaped low echoic cortex and regular cortex.

Figure 5

Ultrasonographic appearance of type 2…

Figure 5

Ultrasonographic appearance of type 2 lymph node metastases. This lymph node (arrow) shows…

Figure 5
Ultrasonographic appearance of type 2 lymph node metastases. This lymph node (arrow) shows well-defined boundaries and weak internal echoes.

Figure 6

Ultrasonographic appearance of type 3…

Figure 6

Ultrasonographic appearance of type 3 lymph node metastases. This lymph node (arrow) shows…

Figure 6
Ultrasonographic appearance of type 3 lymph node metastases. This lymph node (arrow) shows clearly defined boundaries but scattered large internal echoes accompanied by notching.
Figure 2
Figure 2
Five-year disease-free survival curves according to the number of lymph node metastases by ultrasonography.
Figure 3
Figure 3
Five-year disease-free survival curves according to the number of lymph node metastases by histologic examination.
Figure 4
Figure 4
Ultrasonographic appearance of a normal lymph node (type 1). This lymph node (arrow) shows thin C-shaped low echoic cortex and regular cortex.
Figure 5
Figure 5
Ultrasonographic appearance of type 2 lymph node metastases. This lymph node (arrow) shows well-defined boundaries and weak internal echoes.
Figure 6
Figure 6
Ultrasonographic appearance of type 3 lymph node metastases. This lymph node (arrow) shows clearly defined boundaries but scattered large internal echoes accompanied by notching.

References

    1. Krag D., Weaver D., Ashikaga T., Moffat F., Klimberg S., Shriver C., Feldman S., Kusminsky R., Gadd M., Kuhn J. The sentinel node in breast canter-A multicenter validation study. N. Engl. J. Med. 1998;339:941–946. doi: 10.1056/NEJM199810013391401.
    1. Veronesi U., Paganelli G., Viale G., Luini A., Zurrida S., Galimberti V., Intra M., Veronesi P., Robertson C., Maisonneuve P. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N. Engl. J. Med. 2003;349:546–553. doi: 10.1056/NEJMoa012782.
    1. Fisher B., Bauer M., Wickerham D.L., Margolese R., Poisson R., Shibata H., Volk H. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An MSABP update. Cancer. 1983;52:1551–1557. doi: 10.1002/1097-0142(19831101)52:9<1551::AID-CNCR2820520902>;2-3.
    1. Goldhirsch A., Glick J.H., Gelber R.D., Coates A.S., Thurlimann B., Senn H.J., Members P. Meeting highlights: international expert consensus on the primary therapy of early breast cancer. Ann. Oncol. 2005;16:1569–1583. doi: 10.1093/annonc/mdi326.
    1. Sobin L.H., Wittwkind C.H. TNM Classification of Malignant Tumours. 6th edition. John Wiley & Sons; New York, NY, USA: 2002. pp. 31–41.
    1. Wolmark N, Wang J., Mamounas E., Bryant J., Fisher B. Preoperative chemotherapy in patients with operable breast cnacer: nine-year results from national surgical adjuvant breast and bowel project B-18. J. Natl. Cancer. Inst. Monographs. 2001;3:96–102.
    1. Yoshinaka H., Nishi M., Kajisa T., Kuroshima K., Morifuji H. Ultrasonic detection of lymph node metastases in the regional around the celiac axis in esophageal and gastric cancer. J. Clin. Ultrasound. 1985;13:153–160. doi: 10.1002/jcu.1870130302.
    1. Natsugoe S., Yoshinaka H., Shimada M., Sakamoto F., Morinaga T., Nakano S., Kusano C., Baba M., Takao S., Aikou T. Number of lymph node metastases determined by presurgical ultrasound and endoscopic ultrasound is related to prognosis in patients with esophageal carcinoma. Ann. Surg. 2001;234:613–618. doi: 10.1097/00000658-200111000-00005.
    1. Natsugoe S., Yoshinaka H., Shimada M., Shirao K., Nakano S., Kusano C., Baba M., Fukumoto T., Takao S., Aikou T. Assessment of cervical lymph node metastasis in esophageal carcinoma using Ultrasonography. Ann. Surg. 1999;229:62–66. doi: 10.1097/00000658-199901000-00008.
    1. Veronesi U., Cascinelli N., Bufalino R., Morabit A., Mreco M., Galluzzo D., Donne D., De Lellis R., Piotti P., Sacchini V. Risk of internal mammary lymph node metastases and its relevance of prognosis of breast cancer patients. Ann. Surg. 1983;198:681–684. doi: 10.1097/00000658-198312000-00002.
    1. Kjaergaard J., Blichert-Toft M., Anderson J.A., Rank F., Pedersen B.V. Probability of false negative nodal staging in conjuction with partial axillary dissection in breast cancer. Br. J. Surg. 1985;72:365–367. doi: 10.1002/bjs.1800720511.
    1. Graversen H.P., Blichert-Toft M., Andersen J.A., Zedeler K. Breast cancer: risk of axillary recurrence in node-negative patients following partial dissection of the axilla. Eur. J. Surg. Oncol. 1988;14:407–412.
    1. Du Toit R.S., Locker A.P., Ellis I.O., Elston C.W., Blamey R.W. Evaluation of the prognostic value of triple node biopsy in early breast cancer. Br. J. Surg. 1990;77:163–167. doi: 10.1002/bjs.1800770216.
    1. Forrest A.P., Everington D., McDonald C.C., Steele R.J., Chetty U., Stewart H.J. The Edinburgh randomized trial of axillary sampling or clearance after mastectomy. Br. J. Surg. 1995;82:1504–1508. doi: 10.1002/bjs.1800821118.
    1. Ahlgren J., Holmberg L., Bergh J., Liljegren G. Five-node biopsy of the axilla: an alternative to axillary dissection of level I-II in operable breast cancer. Eur. J. Surg. Oncol. 2002;28:97–102. doi: 10.1053/ejso.2001.1228.
    1. Fisher B., Jeong J.H., Anderson S., Bryant J., Fisher E.R., Wolmark N. Twenty-five-year follw-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N. Engl. J. Med. 2000;34:567–575.
    1. Guiliano A.E., Kirgan D.M., Guenther J.M., Morton D.L. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann. Surg. 1997;220:391–398.
    1. Fraile M., Rull M., Julian F.J., Fuste F., Barnadas A., Llatjos M., Castella E., Gonzalez J.R., Vallejos V., Alastrue A., Broggi M.A. Sentinel node biopsy as a practical alternative to axillary lymph node dissection in breast cancer patients: an approach to its validity. Ann. Oncol. 2000;1:701–705.
    1. Veronesi U., Paganelli G., Viale G., Luini A., Zurrida S., Galimberti V., Intra M., Veronessi P., Maisonneuve P, Gatti G., Mazzarol, De Cicco C., Manfredi G., Fernandez J.R. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomized controlled study. Lancet Oncol. 2006;7:983–990. doi: 10.1016/S1470-2045(06)70947-0.
    1. Arima H., Natsugoe S., Uenosono Y., Arigami T., Ehi K., Yanagita S., Higashi H., Ishigami S., Hokita S., Aikou T. Area of nodal metastasis and radioisotope uptake in sentinel nodes of upper gastrointestinal cancer. J. Surg. Res. 2006;135:250–254. doi: 10.1016/j.jss.2006.06.005.
    1. Herrada J., Iyer R.B., Atkinson E.B., Sneige N., Buzdar A.U., Hortobagyi G.N. Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for focally advanced breast carcinoma. Clin. Cancer Res. 1997;3:1565–1569.
    1. Smith J.A., III, Gamez-Araujo J.J., Gallager H.S., White E.C., McBride C.M. Carcinoma of the breast: analysis of total lymph node involvement versus level of metastases. Cancer. 1977;39:527–532. doi: 10.1002/1097-0142(197702)39:2<527::AID-CNCR2820390221>;2-N.
    1. Mittra I., Redkar A.A., Badwe R.A. Prognosis of breast cancer: evidence for interaction between c-erbB-2 overexpression and number of inbolbed axillary lymph nodes. J. Srug. Oncol. 1995;60:106–111. doi: 10.1002/jso.2930600208.
    1. Cascinelli N., Greco M., Bufalino R., Clemente C., Gulluzzo D., delle Donne V., de Lellis R., Sacchini V., Veronesi U. Prognosis of breast cancer with axillary node metastases after surgical treatment only. Eur. J. Cancer Clin. Oncol. 1987;23:795–799. doi: 10.1016/0277-5379(87)90281-1.
    1. Vlastos G., Fornage B.D., Mirza N.Q., Bedi D., Lenert J.T., Winchester D.J., Tolley S.M., Ames F.C., Ross M.I., Feig B.W. The correlation of axillary Ultrasonography with histologic breast cancer downstaging after induction chemotherapy. Am. J. Surg. 2000;179:446–452. doi: 10.1016/S0002-9610(00)00382-2.
    1. Singletary S.E., Allred C., Ashley P., Bassett L.W., Berry D., Bland K.I., Birgen P.I., Clark G., Edge S.B., Hayes D.F. Revision of the American Joint Committee on Cancer staging system for breast cancer. J. Clin. Oncol. 2002;20:3628–3636. doi: 10.1200/JCO.2002.02.026.

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