Abstract
Knowledge of the pathology of axillary lymph nodes (ALN) in breast cancer patients is critical for determining their treatment. Ultrasound is the best noninvasive evaluation for the ALN status. However, the correlation between negative ultrasound results and the sentinel lymph nodes (SLN) pathology remains unknown. To test the hypothesis that negative ultrasound results of ALN predict the negative pathology results of SLN in breast cancer patients, we assessed the association between ALN ultrasonography‐negative results and the SLN pathology in 3115 patients with breast cancer recruited between October 2010 and April 2016 from a single cancer center, prospective database. Of these patients who met the inclusion criteria, 2317 (74.4%) had no SLN pathological metastasis. In the univariate analysis, other 798 patient with positive SLN tended to be under age 40 and premenopausal, having large tumor sizes (>2 cm), higher histological grade of primary tumor, positive hormone receptors, and negative HER‐2 status (P < .05 for all). In the multivariate analysis, menstrual status, tumor size, ER status and histological types of primary tumor remained to be independent predictors for SLN pathological metastasis. The area under curve (AUC) was 0.658 (95% CI = 0.637‐0.679), P > .05. In conclusion, only a 74.4% consistency between ALN ultrasonography‐negative results and negative pathological SLN results, although menstrual status, tumor size, histologic subtypes of primary tumor and ER status were found to be statistically independent predictors of positive SLN among patients negative for ALN ultrasonography. Therefore, the present study suggests that negative ultrasound results of ALN do not adequately predict the negative pathology results of SLN in breast cancer patients.
Highlights
The pathological status of axillary lymph nodes (ALN) is critical in the treatment of breast cancer patients
Axillary lymph nodes pathological status is important in the treatment strategy for breast cancer, and ALN evaluation includes several noninvasive and invasive methods, of which ultrasound has received much attention in modern breast cancer management, because it is noninvasive, highly sensitive to lymph nodes, indicates and guides further possible invasive examinations, and has a high pathological predictive value.[11,12]
Sentinel lymph node (SLN) biopsy is the gold standard for accurately evaluating ALN pathological status in breast cancer patients
Summary
The pathological status of axillary lymph nodes (ALN) is critical in the treatment of breast cancer patients. Sentinel lymph node (SLN) biopsy is the standard of care for clinical management of breast cancer patients.[1,2,3,4] The SLN pathological result-based treatment may prevent patients from undergoing unnecessary ALN dissection. Ultrasound is currently the best noninvasive method to evaluate ALN.[5,6,7,8] Due to improvements in ultrasonography equipment, advances in technology and refined diagnostic standards, the consistency between ALN ultrasonography-n egative results and negative SLN results has been improved. The SOUND (sentinel node vs observation after axillary UltraSouND) trial[9] was established to compare SLN biopsy vs observation, when axillary ultra-s ound is negative in patients with small breast cancer sizes, who are candidates for breast conserving surgery. To our knowledge, few studies have evaluated the association between ALN ultrasonography- negative results and pathological SLN results. We hypothesize that ultrasonography together with clinical indexes predict SLN metastasis for breast cancer patient with ALN ultrasonography-negative results
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