Κατεύθυνση Χειρουργική ΟγκολογίαLibrary of the School of Health Sciences
Βώρος Διονύσιος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Φραγκουλίδης Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεοδοσόπουλος Θεοδόσιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Υπερηχογραφική αξιολόγηση των μασχαλιαίων λεμφαδένων και σύγκριση των αποτελεσμάτων με τη βιοψία του φρουρού λεμφαδένα σε γυναίκες με καρκίνο μαστού.
Ultrasound evaluation of axillary lymph nodes and comparison of the results with the sentinel lymph node biopsy in women with breast cancer.
INTRODUCTION: The pre-surgical staging of the axilla in breast cancer
patients is a vital part of modern surgical oncology since both the prognosis
and the treatment options depend on it. The sentinel lymph node dissection
has become the “gold standard” for the axillary evaluation in patients with
early breast cancer, albeit not without complications or false negative results.
PURPOSE: The scope of this study is to compare specific ultrasound
characteristics of axillary lymph nodes with the result of their histopathology
examination and to test the diagnostic value of ultrasonography in identifying
malignant infiltration. Finally, to estimate if ultrasound alone could possibly
replace the SLNB* in axillary staging.
MATERIALS AND METHODS: In the Breast Unit Department of the 1st
Propaedeutic Surgical Clinic of the University of Athens, 12 women with
histologically proven breast cancer were subjected to ultrasound evaluation of
the axilla. The study took place from February 2018 to July 2018. The lymph
nodes were evaluated with conventional B-mode ultrasound regarding their
morphologic features (shape, cortex, hilum), with Color Doppler regarding
their vascularization pattern and with strain elastography regarding their
stiffness. Suspicious lymph nodes were hook-wired and removed during
sentinel lymph node dissection. The ultrasound results for each node were
finally compared to its histopathology report.
RESULTS: From the evaluation of every distinct sonographic parameter as a
prognostic index of lymph node malignancy, we reached the following
conclusions: “Cortical thickness >3mm” showed the highest sensitivity as an
indication of malignancy (100%). On the other hand this characteristic
presented low specificity (<50%) and accuracy of just 56%. The “lack of fatty
hilum” and “irregular peripheral vascularity” were the two parameters that
showed the maximum specificity (100%) and negative predictive value (88%),
with high diagnostic accuracy (89%) at the same time. Nevertheless the
sensitivity was barely 50% for each one of these two characteristics.
To evaluate the diagnostic accuracy of the sonographic examination as a
whole, we considered two different hypotheses so as to when the examination
a) the ultrasound is positive (=suspicious for malignancy) even with one
abnormal sonographic criterion.
b) the ultrasound is considered positive when at least two sonographic criteria
According to the first hypothesis we reached a high percentage of sensitivity
and negative predictive value (100%) with low specificity (<50%).
Albeit according to the second hypothesis sensitivity goes down to 50% with
an increase in specificity (79%) and with overall higher accuracy (75%
compared to 50% in the first issue).
Finally the addition of strain elastography to the conventional ultrasound
examination doesn’t seem to improve sensitivity, specificity or the accuracy of
CONCLUSIONS: According to the results of this study and the literature
review, we conclude the following: The ultrasound examination with or without
strain elastography cannot replace the sentinel lymph node biopsy at least not
with the contemporary data. When the ultrasound is negative we should
proceed to the SLNB* to minimize the false negative findings. On the other
hand when the ultrasound is positive and proven to be so after percutaneous
sampling, we are allowed to skip the SLNB and proceed to axillary dissection.
Review of large series of patients and testing of novel technologies is
necessary to find out if the ultrasound could possibly replace the “ground
truth” of histopathologic examination, in the future.
Main subject category:
Breast cancer, Axillary lymph nodes, Sentinel node, Ultrasound, Benign/Malignant characteristics, Color doppler, Strain elastography, Staging, Cortical thickness, Hilum loss, Peripheral vascularity.