The Role of US in Depicting Axillary Metastasis in High-Risk Breast Cancer Patients.

Roxana Pintican,Diana Feier,Dan Eniu,Madalina Szep,Iulian Goidescu,Magdalena Maria Duma,Angelica Chiorean

doi:10.3390/jpm11121379

Abstract

Purpose: The aim of this study is to evaluate the role of US in depicting axillary nodal disease in high-risk patients with and without pathogenic mutations. Methods: The retrospective study included consecutive high-risk breast cancer (BC) patients who underwent a multigene testing panel for hereditary cancers, pre-operative axillary US and breast/axillary surgery. The group was divided into patients with pathogenic mutations (PM group) and patients without PM. Statistical analyses were performed using GraphPad Prism by applying Chi-square and Fisher exact tests, with a reference p-value < 0.05 and a CI of 95%. Results: Out of 190 patients with BC, 96 (51%) were negative and 94 (49%) were positive for PM as follows: 28 (25.5%) BRCA1, 16 (17%) BRCA2, 15 (16%) CHECK2, 14 (14%) RAD Group, 7 (7%) PALB, 6 (6%) NBN, 3 (3%) TP53 and ATM and 2 (2%) BARD1. US was positive in 88 of the patients, 36 with PM and 52 without PM. US and surgery (≥N1 stage) were both positive in 31 (62%) of PM patients and 44 (88%) of patients without genetic changes. There were 19 (61%) false negative US examinations in the PM group and 6 (13%) in the group without genetic changes, respectively. If the US is positive, there is a 2.6 times greater risk of positive nodes in PM patients (p-value < 0.000, 95% CI = 4.2–37.9), and a 6.2 times greater risk of positive nodes in patients without genetic changes (p-value < 0.000, 95%CI = 8.4–37.4). In the PM group, US compared to surgery reached a sensitivity = 62, with PPV = 86 and NPV = 67. In the BRCA1/2 subgroup, there is 2.5 greater times risk of nodal disease if the US is positive (p-value = 0.001, 95%CI = 2.6–76). In patients without PM, US compared to surgery reached a sensitivity = 88, PPV = 84 and NPV = 86. Conclusion: US is more sensitive in depicting axillary nodal disease in high-risk patients without PM compared to PM patients. Furthermore, there are more false negative US examinations in PM patients, compared to surgery patients.

Highlights

Axillary nodal disease is an important factor in the staging, management and prognosis of breast cancer (BC) patients
We found that carrier patients of BRCA1, BRCA2, ATM, PALB, CHEK and TP53 mutaNegative tions have 61% false negative axillary US examination, compared to only 13% false negative
The hypothesis should be related to their aggressive histology and behavior, with subgroup high tumoral grade, high proliferative index and high proportion of estrogen receptor (ER) negative tumors leading to an increased risk of axillary micrometastasis

Summary

Introduction

Axillary nodal disease is an important factor in the staging, management and prognosis of breast cancer (BC) patients. The majority of early BC patients will undergo a sentinel lymph node biopsy (SLNB) in order to determine the axillary lymph node status. The. ACOSOG trial showed that, in cases with limited SLNB metastasis, axillary lymph-node dissection (ALND) can be omitted with equal overall survival for patients receiving breast conservative surgery [1,2], suggesting that ultrasound (US) might gain importance in the pre-therapeutic quantification of axillary tumor burden. Recent guidelines recommend US as a part of the pre-therapeutic evaluation of early. BC patients [3,4,5], trying to stratify who will further benefit from SLNB or ALND.

Objectives

Methods

Conclusion