The Preliminary Study Of Assessment Value Of Pre-operative Ultrasound For Axillary Lymph Node Of Clinical Negative Breast Cancer

Part ⅠThe preliminary study of diagnosis performance of pre-operative ultrasound for axillary lymph node of clinically node negative breast cancerObjective:To evaluate the diagnosis performance of pre-operative ultrasound for sentinel lymph node of clinically node negative breast cancer and the predictive value of preoperative ultrasound combined with sentinel lymph node biopsy for the status of non-sentinel lymph nodes.Methods:Preoperative ultrasound was performed by a radiologist with over 20 years of experience for the diagnosis of breast cancer with axillary disease in this department after breast cancer was diagnosed on core biopsy samples. Suspicious morphological characteristics of metastasis included marked hypoechoic echogenicity with a long-to-short axis ratio of<2, the absence of a central fatty hilum, structural changes, and cortical thickening. The LN was diagnosed as ’positive’ if any of these five parameters were abnormal. Results were compared to the final axillary lymph node pathological result.Results:Ninety-six patients with pathologically confirmed invasive breast cancer with clinically negative axillary statuses who were candidates for SLNB in our hospital were recruited. With the metastasis rate of 17.7%,17 of 96 patients in this study were SLN-positive. Preoperative axillary ultrasound identified 8 of the 17 positive SLNs, with a sensitivity 47.1%, specificity 88.6%, positive predictive value of 47.1%, negative predictive value of 88.6%, accuracy of 81.3%.10 of 17 SLN-positive patients in this study were Non-SLN positive, Preoperative axillary ultrasound identified 5 of the 10 patients. The Non-SLN metastasis rate between ultrasound diagnosis of metastasis groups and without metastasis group shows no significant difference (P> 0.05).Conclusion:Preoperative ultrasound proved to be useful in assess the status of SLN; however, preoperative ultrasound combined with sentinel lymph node biopsy cannot predict non-sentinel lymph node metastasis.Part ⅡThe comparison of diagnostic performance among mammography, magnetic resonance imaging, pre-and post-diagnosis ultrasound for axillary lymph node of early stage breast cancerObjective:Compare the diagnostic performance of different imaging modality for axillary lymph node of clinical node negative breast cancer:mammography, magnetic resonance, pre-and post-diagnosis ultrasound.Method:Preoperative ultrasounds were performed in all patients both before and after tissue diagnosis by core needle biopsy (pre-and post-diagnosis ultrasound).Pre-diagnosis ultrasounds were performed by radiologists of this department of ultrasound at random. Post-diagnosis ultrasounds were performed by a radiologist with over 20 years of experience for the diagnosis of breast cancer with axillary disease. Then the magnetic resonance imaging (MRI) and mammography (MG) results in this group of patients was collected. Results were compared to the final axillary lymph node pathological result.Results:Pre-and post-diagnosis ultrasound were performed in all patients, MRI were performed in 79 of 96 patients while MG in 90 of 96 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of pre-diagnosis ultrasound were 23.5%,100%,100%,85.9%,86.5%; Post-diagnosis ultrasound were:47.1%,88.6%,47.1%,88.6%,81.3%. MR 13.3%,96.9%,50.0%, 82.7%,81.0%. and MG 5.9%,95.9%,25.0%,81.4% and 78.9%.Conclusion:Although post-biopsy ultrasounds had an increased sensitivity for identifying positive axillary nodes, false positives occurred. The diagnosis performance of pre-and post diagnosis ultrasound is superior to MG and MRI for clinical node negative breast cancer in sensitivity.