Evaluation Of Axillary Lymph Node Status By Axillary Ultrasonography In Patients With Early Breast Cancer

Objectives:With the improvement of early breast cancer diagnosis methods,the cases of axillary lymph node metastasis have dropped from 50%-75%to 15%-30%.The goal of Axillary Lymph Node Dissection(ALND)or Sentinel Lymph Node Biopsy(SLNB)is the axillary staging of breast cancer rather than the traditional treatment.Surgical intervention may cause various complications,especially irreversible lymphedema.With the improvement of breast cancer treatment and the prolonged survival of patients,surgeons pay more attention to the quality of life of patients.Compared with ALND,the incidence of complications caused by SLNB has been greatly reduced,but the complications in a small number of patients still cannot be ignored.Therefore,the non-invasive method of staging axillary is a recent research hotspot,and ongoing clinical trials such as SOUND are aimed at exploring the feasibility of non-surgical staging of the axillary.In many countries,ultrasound is the preferred method of assessing the status of axillary lymph nodes.The purpose of this study is to evaluate the value and accuracy of preoperative ultrasound in assessing the status of axillary lymph nodes,and to analyze the related factors leading to false negative results,and to explore the suitable population of ultrasound non-invasive axillary staging.Methods:A retrospective analysis of 995 newly diagnosed early breast cancer patients(excluding stage Ⅳ disease)admitted to the Breast Disease Center of Shandong Cancer Hospital Affiliated to Shandong University from May 2013 to November 2019.All patients underwent axillary ultrasound before treatment,and some patients with suspicious lymph nodes underwent fine-needle aspiration cytology under ultrasound examination(US-FNAC。)Compare the ultrasound and cytology data with histological examination results.The accuracy and true negative rate of ultrasound detection are calculated.At the same time,statistical comparisons were made for patients and tumor characteristics in the ultrasound-negative group.Results:995 patients had axillary ultrasound examination,325 had axillary ultrasound positive(of which 141 cases of US-FNAC confirmed metastasis,52 cases were negative,132 cases did not undergo US-FNAC),670 cases of axillary ultrasound were negative,ultrasound examination The accuracy was 75.28%and the negative predictive value was 80.15%.Overall,13.36%(133 cases)had false negative results.The accuracy of fine needle aspiration biopsy was 93.26%,the positive predictive value was 100%,and the negative predictive value was 75.0%.In the ultrasound-negative group,ultrasound tumor size,pathological type,ER,PR,vascular tumor thrombus were significantly correlated with axillary ultrasound false-negative(P<0.05).In multivariate analysis,ultrasound tumor size(OR=1.883 P<0.001)and the presence of vascular tumor thrombi(OR=0.079 P<0.001)were statistically significant.Conclusions:1.Negative axillary ultrasound excludes 80.15%of patients with axillary metastasis,and the accuracy of preoperative axillary ultrasound to assess the status of axillary tumors is 76.48%;2.The accuracy of ultrasound-guided fine-needle aspiration biopsy is 93.26%,and the positive predictive value is 100%.For preoperative ultrasound-guided fine-needle aspiration biopsy of suspicious lymph nodes,the number of ultrasound false positives can be reduced and the axillary status can be more accurately assessed;3.This study found that there were significant differences in ultrasound tumor size,pathological type,ER,PR,and vascular tumor thrombi in the true-negative and false-negative groups of axillary ultrasonography,especially in the case of cT2 and the presence of vascular tumor thrombi.Decreased accuracy in assessing the state of the axilla;4.In the study of cTl patients,there were 432 ultrasound-negative cases,74 false-negative cases(17.12%),and 358 true-negative cases(82.88%),which were similar to the latest reported value(84.6%)in the SOUND study,or could be a follow-up test The results have been further recognized and promoted in our Breast Disease Center and even in my country;5.Confirming lymph node metastasis before treatment can make a diagnosis and treatment plan more accurate.Ultrasound is a non-invasive method to predict the burden of axillary tumors and a powerful tool for individualized treatment planning.However,prospective studies are still needed to further confirm the relationship between preoperative ultrasound evaluation and axillary surgery in patients with early breast cancer.