Korean Journal of Radiology

  • 제25권2호
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  • Pages.146-156
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  • 2024
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Automated Versus Handheld Breast Ultrasound for Evaluating Axillary Lymph Nodes in Patients With Breast Cancer

  • Sun Mi Kim (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Mijung Jang (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Bo La Yun (Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Sung Ui Shin (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Jiwon Rim (Department of Radiology, CHA Bundang Medical Center, CHA University) ;
  • Eunyoung Kang (Department of Surgery, Daerim St. Mary's Hospital) ;
  • Eun-Kyu Kim (Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hee-Chul Shin (Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • So Yeon Park (Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Bohyoung Kim (Division of Biomedical Engineering, Hankuk University of Foreign Studies)
  • 투고 : 2023.01.31
  • 심사 : 2023.11.07
  • 발행 : 2024.02.01
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초록

Objective: Automated breast ultrasound (ABUS) is a relevant imaging technique for early breast cancer diagnosis and is increasingly being used as a supplementary tool for mammography. This study compared the performance of ABUS and handheld ultrasound (HHUS) in detecting and characterizing the axillary lymph nodes (LNs) in patients with breast cancer. Materials and Methods: We retrospectively reviewed the medical records of women with recently diagnosed early breast cancer (≤ T2) who underwent both ABUS and HHUS examinations for axilla (September 2017-May 2018). ABUS and HHUS findings were compared using pathological outcomes as reference standards. Diagnostic performance in predicting any axillary LN metastasis and heavy nodal-burden metastases (i.e., ≥ 3 LNs) was evaluated. The ABUS-HHUS agreement for visibility and US findings was calculated. Results: The study included 377 women (53.1 ± 11.1 years). Among 385 breast cancers in 377 patients, 101 had axillary LN metastases and 30 had heavy nodal burden metastases. ABUS identified benign-looking or suspicious axillary LNs (average, 1.4 ± 0.8) in 246 axillae (63.9%, 246/385). According to the per-breast analysis, the sensitivity, specificity, positive and negative predictive values, and accuracy of ABUS in predicting axillary LN metastases were 43.6% (44/101), 95.1% (270/284), 75.9% (44/58), 82.6% (270/327), and 81.6% (314/385), respectively. The corresponding results for HHUS were 41.6% (42/101), 95.1% (270/284), 75.0% (42/56), 82.1% (270/329), and 81.0% (312/385), respectively, which were not significantly different from those of ABUS (P ≥ 0.53). The performance results for heavy nodal-burden metastases were 70.0% (21/30), 89.6% (318/355), 36.2% (21/58), 97.3% (318/327), and 88.1% (339/385), respectively, for ABUS and 66.7% (20/30), 89.9% (319/355), 35.7% (20/56), 97.0% (319/329), and 88.1% (339/385), respectively, for HHUS, also not showing significant difference (P ≥ 0.57). The ABUS-HHUS agreement was 95.9% (236/246; Cohen's kappa = 0.883). Conclusion: Although ABUS showed limited sensitivity in diagnosing axillary LN metastasis in early breast cancer, it was still useful as the performance was comparable to that of HHUS.

키워드

과제정보

The authors would like to thank the Division of Statistics of the Medical Research Collaborating Center at Seoul National University Bundang Hospital for their statistical analyses.

참고문헌

  1. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471-1474 
  2. Siegel BM, Mayzel KA, Love SM. Level I and II axillary dissection in the treatment of early-stage breast cancer. An analysis of 259 consecutive patients. Arch Surg 1990;125:1144-1147 
  3. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349:546-553 
  4. Zavagno G, De Salvo GL, Scalco G, Bozza F, Barutta L, Del Bianco P, et al. A randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM trial. Ann Surg 2008;247:207-213 
  5. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 2007;8:881-888 
  6. Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, Kelemen PR, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial. JAMA 2017;318:918-926 
  7. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 2011;305:569-575 
  8. Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 2006;186:1342-1348 
  9. Houssami N, Ciatto S, Turner RM, Cody HS 3rd, Macaskill P. Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla. Ann Surg 2011;254:243-251 
  10. Bhole S, Friedewald SM. Lymph node staging in newly diagnosed breast cancer: counterpoint-sentinel biopsy surpasses axillary imaging in early-stage cancers, but is the sun setting on this controversy? AJR Am J Roentgenol 2022;218:600-601 
  11. Viers LD, Hunt KN. Lymph node staging in newly diagnosed breast cancer: point-preoperative staging axillary ultrasound is valuable in the contemporary evaluation of newly diagnosed breast cancer. AJR Am J Roentgenol 2022;218:598-599 
  12. Boca Bene I, Ciurea AI, Ciortea CA, Dudea SM. Pros and cons for automated breast ultrasound (ABUS): a narrative review. J Pers Med 2021;11:703 
  13. Wilczek B, Wilczek HE, Rasouliyan L, Leifland K. Adding 3D automated breast ultrasound to mammography screening in women with heterogeneously and extremely dense breasts: report from a hospital-based, high-volume, single-center breast cancer screening program. Eur J Radiol 2016;85:1554-1563 
  14. Vourtsis A, Kachulis A. The performance of 3D ABUS versus HHUS in the visualisation and BI-RADS characterisation of breast lesions in a large cohort of 1,886 women. Eur Radiol 2018;28:592-601 
  15. Kwon BR, Chang JM, Kim SY, Lee SH, Kim SY, Lee SM, et al. Automated breast ultrasound system for breast cancer evaluation: diagnostic performance of the two-view scan technique in women with small breasts. Korean J Radiol 2020;21:25-32 
  16. American College of Radiology. Breast imaging reporting and data system. 5th ed. Reston, VA: American College of Radiology, 2013 
  17. Ahn HS, Kim SM, Jang M, Yun B, Kang E, Kim EK, et al. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy can predict a heavy nodal metastatic burden in early-stage breast cancer. Ultrasonography 2021;40:520-529 
  18. Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, et al. Tailoring therapies--improving the management of early breast cancer: St Gallen international expert consensus on the primary therapy of early breast cancer 2015. Ann Oncol 2015;26:1533-1546 
  19. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174 
  20. Hunter JV, Hunter GJ, Tucker AK. Patterns of axillary lymphadenopathy demonstrated by mammography: implications for the asymptomatic woman in a breast screening programme. Clin Radiol 1987;38:515-517 
  21. Podkrajsek M, Music MM, Kadivec M, Zgajnar J, Besic N, Pogacnik A, et al. Role of ultrasound in the preoperative staging of patients with breast cancer. Eur Radiol 2005;15:1044-1050 
  22. 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 
  23. Moorman AM, Bourez RL, Heijmans HJ, Kouwenhoven EA. Axillary ultrasonography in breast cancer patients helps in identifying patients preoperatively with limited disease of the axilla. Ann Surg Oncol 2014;21:2904-2910 
  24. Jackson RS, Mylander C, Rosman M, Andrade R, Sawyer K, Sanders T, et al. Normal axillary ultrasound excludes heavy nodal disease burden in patients with breast cancer. Ann Surg Oncol 2015;22:3289-3295 
  25. Luo H, Mo Y, Zhong J, Zhang Y, Zhu L, Shi X, et al. Preoperative axillary ultrasound helps in the identification of a limited nodal burden in breast cancer patients. Ultrasound Q 2020;36:173-178 
  26. Kim WH, Kim HJ, Lee SM, Cho SH, Shin KM, Lee SY, et al. Prediction of high nodal burden with ultrasound and magnetic resonance imaging in clinically node-negative breast cancer patients. Cancer Imaging 2019;19:4 
  27. Kim SH, Kang BJ, Choi BG, Choi JJ, Lee JH, Song BJ, et al. Radiologists' performance for detecting lesions and the interobserver variability of automated whole breast ultrasound. Korean J Radiol 2013;14:154-163 
  28. Kim EJ, Kim SH, Kang BJ, Kim YJ. Interobserver agreement on the interpretation of automated whole breast ultrasonography. Ultrasonography 2014;33:252-258 
  29. Zhu Y, Zhou JQ, Jia XH, Zhou W, Zhan WW. Interobserver variability between experienced radiologists in evaluating the number of abnormal lymph nodes seen on preoperative axillary ultrasound. Clin Radiol 2021;76:60-66 
  30. 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