Preoperative Evaluation Value Of Axillary Lymph Node Metastasis Determined By US-based Scoring System In Breast Cancer

Objective: Axillary lymph node metastasis(ALNM)is an important predictor for breast cancer recurrence and prognosis,but invasive dissection or biopsy is required for the diagnosis.We determined how malignant nodes could be diagnosed and whether the number of malignant nodes could be confirmed preoperatively with axillary ultrasound(AUS).Methods: Between April 2016 and June 2017,we evaluated 356 breast cancer patients and 371 axillary lymph nodes with AUS.Two experienced radiologists preoperatively assessed sonograms by the sum of scores for 4 criteria: hilum and cortex morphology,shape of lymph node and vascularization.All patients were classified according to the number of malignant axillary lymph nodes(0;1-2;3-9;10+).With pathological results as the gold standard,sensitivity,specificity,accuracy and the area under the ROC curve(AUC)were examined to help select criteria for diagnosing axillary lymph node metastasis and compared in the entire study group and in the subgroups according to the subdivision of number of ALNM.Differences were considered to be statistically significant at P<0.05.Results: With pathologic diagnosis as the reference standard,US-based scoring system for diagnosing malignant axillary lymph nodes were 98.0% sensitive,86.5% specific,91.1% accurate and AUC value of scoring system(0.922)was higher than the single criteria.Level I(score 0)had the highest accuracy(100%)and level III(score 3)had the lowest accuracy(65.2%)with significant difference(P<0.05). The accuracy of preoperative ultrasound diagnosis was 79.7% sort by axilla.According to the subdivision of number of ALNM(0,1�2,3�9,10+),the accuracy rates associated with ALNM were 82%,49%,34%,and 86%,respectively.We achieved a significantly higher accuracy(90.7%)in subdivision of 0-2 than that of the subdivision of 0?1-2 and 3-9.Conclusion: Metastatic axillary lymph nodes can be accurately diagnosed and the scoring system appears to be superior to current methods.Number of malignant axillary lymph nodes can be appropriatly determined by AUS in women with breast cancer preoperatively and non-invasively which can provide more comprehensive and reliable information for clinical decision and avoid unnecessary invasive lymph node dissection or biopsy.