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Preoperative Axillary Ultrasound in the Selection of Patients With a Heavy Axillary Tumor Burden in Early‐Stage Breast Cancer: What Leads to False‐Positive Results?
Author(s) -
Zhu Ying,
Zhou Wei,
Jia Xiaohong,
Huang Ou,
Zhan Weiwei
Publication year - 2018
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14545
Subject(s) - medicine , breast cancer , axillary lymph nodes , axilla , radiology , stage (stratigraphy) , univariate analysis , logistic regression , oncology , cancer , multivariate analysis , paleontology , biology
Objectives To determine whether imaging and clinicopathologic features could predict false‐positive axillary ultrasound (US) results in the selection of patients with breast cancer who had a heavy axillary tumor burden (≥3 tumor‐involved nodes). Methods Among 788 patients with histologically confirmed invasive breast cancer at Ruijin Hospital from October 2014 to September 2015, 162 patients (cT1‐T2, cN0) with 167 axillae had suspicious axillary US findings. Ultrasound findings were considered suspicious for metastasis if cortical thickening of greater than 3 mm or effacement of the fatty hilum was present. The false‐positive rate of suspicious axillary US results for identifying 3 or more positive lymph nodes in the final pathologic examination was calculated. Univariate and multivariate analyses were used to evaluate imaging and clinicopathologic factors related to the false‐positive results. Results Axillary US showed a false‐positive rate of 60.5% (101 of 167) in the patients with breast cancer and a heavy nodal burden. By logistic regression analyses, we found false‐positive axillary US results more frequently in patients who had a T1 stage tumor ( P = .005), an estrogen receptor/progesterone receptor–negative tumor ( P < .001), solitary suspicious nodes identified on axillary US ( P < .001), and a cortical thickness of the most suspicious lymph node of 3.5 mm or less ( P = .015). Conclusions Imaging and clinicopathologic features can be used to identify axillae with less than 3 metastatic nodes in patients with early‐stage breast cancer who have positive axillary US results. In the post–American College of Surgeons Oncology Group Z0011 trial era, conducting a secondary evaluation either clinically or by axillary imaging before the use of a US‐guided biopsy of suspicious nodes can potentially avoid the additional morbidity of axillary lymph node dissection and reduce the preoperative workload.