Accuracy of Ultrasound-Guided Core Biopsy for Staging Axilla in Clinically Node-Negative Patients with Invasive Breast Cancer Taking Histopathology as Gold Standard
Keywords:
Axillary, Biopsy, Breast Neoplasms, Lymph NodesAbstract
Objective: To assess the accuracy of ultrasound-guided core biopsy in staging axillary lymph nodes in clinically
node-negative invasive breast cancer patients using histopathology as the gold standard.
Methods: This cross-sectional study was conducted in the Department of Pathology at Mekran Medical College, Turbat, Pakistan, from April 2023 to September 2023. The study included breast cancer patients who were clinically negative for lymph node involvement. Ultrasound-guided core biopsies were performed on suspicious axillary lymph nodes by experienced radiologists, with histopathological analysis serving as the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated to assess diagnostic performance. Patient demographics, tumor characteristics, and axillary ultrasound findings were also recorded. Results: A total of 132 invasive breast cancer patients were included, with a mean age of 57.67 ± 13.03 years. The majority of patients were diagnosed with invasive ductal carcinoma, accounting for 113 (85.6%) cases. Hormone receptor positivity was prevalent, with estrogen receptor positivity in 119 (90.2%) and progesterone receptor positivity in 116 (87.9%) cases. The most common immunohistochemistry subtype was Luminal B, present in 66 (50%) patients, followed by Luminal A in 51 (38.6%) patients. Most tumors were of moderate grade 77 (58.4%) and early-stage (pT1) 63 (47.7%). Ultrasound-guided core biopsy exhibited a sensitivity of 87.9% and specificity of 100%,
with positive and negative predictive values of 100% and 89.2% respectively, resulting in a diagnostic accuracy of
93.9%.
Conclusion: Ultrasound-guided core biopsy demonstrates strong diagnostic performance in identifying
metastatic axillary lymph nodes in clinically node-negative invasive breast cancer patients.
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Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomat-aram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71:209-49. doi:10.3322/caac.21660
Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast 2022; 66:15-23. doi:10.1016/j.breast.2022.08.010
Lukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanisławek A. Breast cancer-epidemiology, risk factors, classification, prognostic markers, and current treatment strategies-an updated review. Cancers (Basel) 2021; 13:4287. doi:10.3390/cancers13174287
Feng Y, Spezia M, Huang S, Yuan C, Zeng Z, Zhang L, et al. Breast cancer development and progression: Risk factors, cancer stem cells, signaling pathways, genomics, and molecular pathogenesis. Genes Dis 2018; 5:77-106. doi:10.1016/j.gendis.2018.05.001
Qureshi MA, Khan S, Sharafat S, Quraishy MS. Common cancers in karachi, Pakistan: 2010-2019 cancer data from the Dow cancer registry. Pak J Med Sci 2020; 36:1572-8. doi:10.12669/pjms.36.7.3056
Zaheer S, Yasmeen F. Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis. Pak J Med Sci 2024; 40:134-9. doi:10.12669/pjms.40.1.7123
Rahim A, Sattar A, Adil SO, Khan SA. Positive predictive value of Birads IV Lesions on mammogram in detection of breast carcinoma. J Pak Med Assoc 2022; 72:1750-4. doi:10.47391/JPMA.3957
Risom T, Glass DR, Averbukh I, Liu CC, Baranski A, Kagel A, et al. Transition to invasive breast cancer is associated with progressive changes in the structure and composition of tumor stroma. Cell 2022; 185:299-310. doi:10.1016/j.cell.2021.12.023
Chen MY, Gillanders WE. Staging of the axilla in breast cancer and the evolving role of axillary ultrasound. Breast Cancer (Dove Med Press) 2021; 13:311-23. doi:10.2147/BCTT.S273039
Brackstone M, Baldassarre FG, Perera FE, Cil T, Chavez Mac Gregor M, Dayes IS, et al. Management of the axilla in early-stage breast cancer: ontario health (Cancer Care Ontario) and ASCO guideline. J Clin Oncol 2021; 39:3056-82. doi:10.1200/JCO.21.00934
Davey MG, Kerin EP, McLaughlin RP, Barry MK, Malone CM, Elwahab SA, et al. Evaluating the necessity for routine sentinel lymph node biopsy in postmenopausal patients being treated for clinically node negative breast cancer the era of RxPONDER. Clin Breast Cancer 2023; 23:500-7. doi:10.1016/j.clbc.2023.03.011
Saltarin LL, Bue GL, Garcia - Etienne CA, Morenghi E, Tommaso LD. Accuracy of axillary ultrasound in the detection of nodal metastasis in breast cancer: experience on 620 cases. J Cancer Prev Curr Res 2016; 6:00212-23. doi:10.15406/jcpcr.2016.06.00212
Wang X, Chen L, Sun Y, Zhang B. Evaluation of axillary lymph node metastasis burden by preoperative ultrasound in early-stage breast cancer with needle biopsy-proven metastasis. Clin Transl Oncol 2020; 22:468-73. doi:10.1007/s12094-019-02162-3
Xu Q, Wang J, Wang J, Guo R, Qian Y, Liu F. The effectiveness of ultrasound-guided core needle biopsy in detecting lymph node metastases in the axilla in patients with breast cancer: Systematic review and meta-analysis. Clinics (Sao Paulo) 2023; 78:100207. doi:10.1016/j.clinsp.2023.100207
Chang JM, Leung JWT, Moy L, Ha SM, Moon WK. Axillary nodal evaluation in breast cancer: state of the art. Radiology 2020; 295:500-15. doi:10.1148/radiol.2020192534
Ge I, Erbes T, Juhasz-Boss I. Prognostic value and management of regional lymph nodes in locoregional breast cancer recurrence: A systematic review of the literature. Arch Gynecol Obstet 2022; 306:943-57. doi:10.1007/s00404-021-06352-9
Zheng H, Zhao R, Wang W, Liu X, Wang X, Wen C, et al. The accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph nodes in women with breast cancer: A systematic review and meta-analysis. Front Oncol 2023; 13:1166035. doi:10.3389/fonc.2023.1166035
Javid MS, Barry M. Axillary Ultrasound as preoperative staging in clinical negative axillary lymph node breast cancer patient. Pak J Med Health Sci 2021; 15:1222-4. doi:10.53350/pjmhs211551222
Riedel F, Schaefgen B, Sinn HP, Feisst M, Hennigs A, Hug S, et al. Diagnostic accuracy of axillary staging by ultrasound in early breast cancer patients. Eur J Radiol 2021; 135:109468. doi:10.1016/j.ejrad.2020.109468
Mwaniki D. Diagnostic accuracy of axillary ultrasound in predicting nodal metastasis among patients with early breast cancer at Aga Khan University Hospital, Nairobi. J Pak Med Assoc 2022; 60:31-3. doi:10.47391/JPMA.AKU-123
Afzal S, Masroor I, Munir A, Idress R, Khan P, Khan S. Preoperative ultrasound-guided core biopsy of axillary nodes for staging of clinically negative axilla in breast cancer patients - A pilot study. Cureus 2020; 12:e6718. doi:10.7759/cureus.6718
Hu X, Zhou X, Yang H, Wei W, Jiang Y, Liu J. Axillary ultrasound and fine needle aspiration biopsy in the preoperative diagnosis of axillary metastases in early-stage breast cancer. Oncol Lett 2018; 15:8477-83. doi:10.3892/ol.2018.8445
Stachs A, Gode K, Hartmann S, Stengel B, Nierling U, Dieterich M, et al. Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer - size of metastases as limiting factor. Springerplus 2013; 2:350. doi:10.1186/2193-1801-2-350
Houssami N, Ciatto S, Turner RM, Cody HS. Preoperative staging of the axilla in women with invasive breast cancer. Breast Cancer Manag 2012; 1:65-72. doi:10.7497/j.issn.2095-3941.2014.02.001
Mu WN, Li JH, Liu Y, Wen Y, Liu X. Clinical application of ultrasound-guided core needle biopsy histology and fine needle aspiration cytology in cervical lymph nodes. Pak J Med Sci 2023; 39:752-6. doi:10.12669/pjms.39.3.6630
Abidi SS, Vohra LM, Kerawala AA, Masroor I, Tahseen MU. Diagnostic accuracy of axillary nodal ultrasound after neoadjuvant chemotherapy in node-positive breast cancer patients: A validation study. J Pak Med Assoc 2022; 72:S25-S9. doi:10.47391/JPMA.AKU-06
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