Marie Adele Ganott MD, Abstract Co-Author: Nothing to Disclose

Scott Rudzinski MD, Presenter: Nothing to Disclose

Margarita Louise Zuley MD, Abstract Co-Author: Research grant, Hologic, Inc

Christiane Hakim MD, Abstract Co-Author: Nothing to Disclose

Dilip Digambar Shinde MD, Abstract Co-Author: Nothing to Disclose

Jules Henry Sumkin DO, Abstract Co-Author: Scientific Advisory Board, Hologic, Inc

To determine if axillary ultrasound can accurately predict  the number of metastatic lymph nodes in patients with carcinoma in the ipsilateral breast.

The prospectively predicted number of metastatic lymph nodes and their morphology on axillary ultrasound were reviewed and correlated  with surgical pathology  from sentinel node excision or axillary dissection in 43 consenting patients with concurrent carcinoma in the ipsilateral breast.  These patients were a subset (those having surgery without neoadjuvant chemotherapy) of a larger IRB approved study group undergoing axillary ultrasound and percutaneous biopsy of a lymph node suspected to harbor metastasis. Data recorded at the time of percutaneous node biopsy were cortical thickness, shape, hilar presence or absence, and abnormal cortical flow in the biopsied node. Node shape was described as ill- defined, round, focal bulge, or normal. The predicted number of abnormal nodes was recorded as 1,2,3, or 4 or more. Morphologic features were correlated with accuracy of prediction to determine if there was a subset of patients in whom ultrasound is more accurate.

22 (51%) of the 43  patients had 1 to 9 metastatic axillary nodes at surgery. The number of metastatic nodes was accurately predicted in 11 (26%) patients, underestimated in 13 (30%), and overestimated in 19 (44%) patients. When the node chosen for percutaneous biopsy was over 6 mm in cortical thickness, the number of positive nodes was most often under (7/13)(46%) or accurately (3/13)(31%) assessed.  When the biopsied node cortical thickness was 4.1 to 6mm and had  a non-normal shape, the number was under estimated (6/6).   Biopsied nodes with cortical thickness of 2.1 to 4 mm were associated with overestimation most often (14/22 patients) (64%). Hilar absence was associated with less overestimation (2/8)(25%) than hilar presence (18/35 patients)(49%).

Despite using established morphologic criteria for predicting axillary lymph node metastasis, assessment of the number of metastatic nodes using axillary ultrasound in breast cancer patients is not highly accurate. However, ultrasound is less likely to overestimate metastatic disease in patients whose nodes are most abnormal in appearance.

As surgeons eliminate axillary dissection for T1 and T2 breast cancers with 2 or less positive sentinel nodes, the value of ultrasound may be limited to those with the most abnormal node morphology.

Ganott, M, Rudzinski, S, Zuley, M, Hakim, C, Shinde, D, Sumkin, J, Axillary Ultrasound in Patients with Ipsilateral Breast Cancer: Can We Accurately Predict the Number of Metastatic Lymph Nodes?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010297.html