Value of Axillary Ultrasound after Negative Axillary MRI for Evaluating Nodal Status in High-Risk Breast Cancer

Journal of the American College of Surgeons
Tariq AlmereySarah A McLaughlin

Abstract

It is assumed axillary ultrasound (AxUS) is the best method for axillary nodal evaluation in newly diagnosed breast cancer patients. However, few have evaluated the efficacy of preoperative axillary MRI. Herein, we compare the statistical accuracy of AxUS and MRI in detecting nodal metastases among breast cancer patients who were selected for neoadjuvant chemotherapy. We retrospectively analyzed 219 breast cancer patients undergoing neoadjuvant chemotherapy from 2007-2015 all of whom had AxUS and breast MRI prior to-chemotherapy. Two breast radiologists blinded to clinical, pathological and AxUS findings re-reviewed all breast MRIs specifically focusing on axillary nodal characteristics. We correlated clinico-pathological characteristics, AxUS and MRI findings and quantified predictive values of both imaging modalities. Overall, 101/219 (47%) patients had T2 tumors. The most common abnormal nodal finding was size >10mm. AxUS and MRI agreed on nodal status in 192/219 (87.6%). When correlated with prechemotherapy needle biopsy in 129 patients; AxUS and axillary MRI performed similarly (Sensitivity of 99.1% vs 97.4% and specificity 15.4% vs 15.4%, respectively). Only 4/129 (3.1%) patients had a negative MRI and positive AxUS of wh...Continue Reading

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