Mode of presentation and skin thickening on ultrasound may predict nodal burden in breast cancer patients with a positive axillary core biopsy

Wen Ling Choong (Lead / Corresponding author), Andrew Evans, Colin Purdie, Huan Wang, Peter T. Donnan, Brooke Lawson, Jane Macaskill

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: A number of pre-operative factors predicting nodal burden in females with breast cancer have recently been identified. The aim of this study is to assess if these factors independently influence nodal burden in females with a positive axillary core biopsy. METHODS: All node positive patients detected on axillary core biopsy were identified in our cancer audit database. Mode of presentation, age, core tumour grade, core tumour type, ER and HER2 status were evaluated. Tumours were assessed for ultrasound size, distance of tumour-to-skin, presence of invasion of skin and diffuse skin thickening. Axillary lymph nodes were assessed for cortical thickness and presence of ultrasound replaced nodes. Statistical significance was ascertained using univariate logistic regression. A predictive model was produced following a multiple logistic regression model incorporating cross-validation and assessed using receiving operating characteristic curve. RESULTS: 115 patients' data were analysed. Patients referred because of symptoms (70% vs 38%, p = 0.005), and those with ultrasound skin thickening (87% vs 59%, p = 0.055) have higher nodal burden than those referred from screening or without skin thickening. These factors were significant after multivariate analysis. The final predictive model included mode of presentation, ultrasound tumour size, cortical thickness and presence of ultrasound skin thickening. The area under curve is 0.77. CONCLUSION: We have shown that mode of presentation and ultrasound skin thickening are independent predictors of high nodal burden at surgery. A model has been developed to predict nodal burden pre-operatively, which may lead to avoidance of axillary node clearance in patients with lower nodal burden. ADVANCES IN KNOWLEDGE: Method of presentation and skin involvement/proximity to skin by the primary tumour are known to influence outcome and nodal involvement respectively but have not been studied with regard to nodal burden. We have shown that mode of presentation and skin thickening at ultrasound are independent predictors of high nodal burden at surgery.

Original languageEnglish
Article number20190711
Pages (from-to)1-7
Number of pages7
JournalBritish Journal of Radiology
Volume93
Issue number1108
Early online date28 Jan 2020
DOIs
Publication statusPublished - Apr 2020

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Axilla
  • Biopsy, Large-Core Needle
  • Breast Neoplasms/diagnostic imaging
  • Female
  • Humans
  • Logistic Models
  • Lymph Node Excision/adverse effects
  • Lymph Nodes/diagnostic imaging
  • Lymphatic Metastasis/diagnostic imaging
  • Middle Aged
  • Preoperative Period
  • Reproducibility of Results
  • Retrospective Studies
  • Skin/diagnostic imaging
  • Ultrasonography

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