Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm

Joachim Diessner, Laura Anders, Saskia Herbert, Matthias Kiesel, Thorsten Bley, Tanja Schlaiss, Stephanie Sauer, Achim Wöckel, Catharina Bartmann, Joachim Diessner, Laura Anders, Saskia Herbert, Matthias Kiesel, Thorsten Bley, Tanja Schlaiss, Stephanie Sauer, Achim Wöckel, Catharina Bartmann

Abstract

Purpose: The reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography.

Methods: Data for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study. All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes.

Results: All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity.

Conclusion: We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies.

Keywords: Breast cancer imaging; Conventional imaging; Cross-sectional imaging; Neoadjuvant therapies; Positive nodal status; Post-neoadjuvant therapies.

Conflict of interest statement

The authors declare no competing interests.

The authors have no relevant financial or non-financial interests to disclose.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The imaging example illustrates the case of a patient in whom the suspicious lymph node was primarily diagnoses via CT imaging. A: Mammography in mediolateral oblique projection depicting invasive breast cancer (no special type, G3) as a mass with architectural distortion and peritumoral ductal carcinoma in situ (DCIS), indicated by accompanying regional distribution of fine linear branching microcalcifications in the right upper outer quadrant. No axillary lymph nodes are included in the field of view. B: Axial and coronal reformatting of contrast-enhanced chest CT shows asymmetrical enlargement of one right axillary lymph node with nodular thickening of the cortex (arrows). C: Following CT, focused ultrasound of the right axilla confirmed focal nodular thickening, while visualizing an aberrant small vessel within the otherwise homogenously thickened lymph node cortex. Core needle biopsy revealed a nodal metastasis of breast cancer

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