Computed tomography Hounsfield units can predict breast cancer metastasis to axillary lymph nodes.

Masakazu Urata,Kosei Maemura,Hideo Arima,Akihiro Nakajo,Sumiya Ishigami,Yoshiaki Shinden,Chihaya Koriyama,Hiroshi Okumura,Yuko Kijima,Yoshikazu Uenosono,Heiji Yoshinaka,Shoji Natsugoe,Munetsugu Hirata,Takaaki Arigami

doi:10.1186/1471-2407-14-730

Abstract

BackgroundAxillary lymph node (ALN) status is an important prognostic factor for breast cancer. We retrospectively used contrast-enhanced computed tomography (CE-CT) to evaluate the presence of ALN, metastasis based on size, shape, and contrasting effects.MethodsOf 131 consecutive patients who underwent CE-CT followed by surgery for breast cancer between 2005 and 2012 in our institution, 49 were histologically diagnosed with lymph node metastasis. Maximum Hounsfield units (HU) and mean HU were measured in non-contrasting CT (NC-CT) and CE-CT of ALNs.ResultsOf 12 examined measurements, we found significant differences between negative and metastatic ALNs in mean and maximum NC-CT HU, and mean and maximum CE-CT HU (P < 0.05). We used a receiver operating curve, to determine cut-off values of four items in which significant differences were observed. The highest accuracy rate was noted for the cut-off value of 54 as maximum NC-CT HU for which sensitivity, specificity, and accuracy rate were 79.6%, 80.5% and 80.2%, respectively.ConclusionsCT HU of a patient with breast cancer are absolute values that offer objective disease management data that are not influenced by the screener’s ability.

Highlights

Axillary lymph node (ALN) status is an important prognostic factor for breast cancer
The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial showed that patients randomized to Sentinel lymph node (SLN) dissection (SLND) alone or to SLND + ALN dissection (ALND), did not significantly differ in local or regional recurrence [21]
The ACOSOGZ0011 enrolled patients who were diagnosed as N0 before randomization, which supports the importance of preoperative ALN evaluation

Summary

Introduction

Axillary lymph node (ALN) status is an important prognostic factor for breast cancer. We retrospectively used contrast-enhanced computed tomography (CE-CT) to evaluate the presence of ALN, metastasis based on size, shape, and contrasting effects. Status of axillary lymph nodes (ALNs) is the most important predictor of survival [2]. Contrast-enhanced computed tomography (CE-CT) has been used to evaluate ALN metastasis based on size, shape, and contrasting effects [5,6,7,8,9,10]. Use of whole-body 18 F-fluorodeoxy glucosepositron emission tomography (FDG-PET)/CT for breast cancer staging and treatment monitoring has recently increased due to its ability to detect previously unknown metastases [11,12,13,14,15,16]. Its diagnostic accuracy for ALN staging has not yet been established [16,17]

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Discussion

Conclusion