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      Computed tomography Hounsfield units can predict breast cancer metastasis to axillary lymph nodes

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          Abstract

          Background

          Axillary lymph node (ALN) status is an important prognostic factor for breast cancer. We retrospectively used contrast-enhanced computed tomography (CE-CT) to evaluate the presence of ALN, metastasis based on size, shape, and contrasting effects.

          Methods

          Of 131 consecutive patients who underwent CE-CT followed by surgery for breast cancer between 2005 and 2012 in our institution, 49 were histologically diagnosed with lymph node metastasis. Maximum Hounsfield units (HU) and mean HU were measured in non-contrasting CT (NC-CT) and CE-CT of ALNs.

          Results

          Of 12 examined measurements, we found significant differences between negative and metastatic ALNs in mean and maximum NC-CT HU, and mean and maximum CE-CT HU ( P < 0.05). We used a receiver operating curve, to determine cut-off values of four items in which significant differences were observed. The highest accuracy rate was noted for the cut-off value of 54 as maximum NC-CT HU for which sensitivity, specificity, and accuracy rate were 79.6%, 80.5% and 80.2%, respectively.

          Conclusions

          CT HU of a patient with breast cancer are absolute values that offer objective disease management data that are not influenced by the screener’s ability.

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          Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial.

          Armando E. Giuliano, Linda McCall, Peter Beitsch … (2010)
          Sentinel lymph node dissection (SLND) has eliminated the need for axillary dissection (ALND) in patients whose sentinel node (SN) is tumor-free. However, completion ALND for patients with tumor-involved SNs remains the standard to achieve locoregional control. Few studies have examined the outcome of patients who do not undergo ALND for positive SNs. We now report local and regional recurrence information from the American College of Surgeons Oncology Group Z0011 trial. American College of Surgeons Oncology Group Z0011 was a prospective trial examining survival of patients with SN metastases detected by standard H and E, who were randomized to undergo ALND after SLND versus SLND alone without specific axillary treatment. Locoregional recurrence was evaluated. There were 446 patients randomized to SLND alone and 445 to SLND + ALND. Patients in the 2 groups were similar with respect to age, Bloom-Richardson score, estrogen receptor status, use of adjuvant systemic therapy, tumor type, T stage, and tumor size. Patients randomized to SLND + ALND had a median of 17 axillary nodes removed compared with a median of only 2 SN removed with SLND alone (P < 0.001). ALND also removed more positive lymph nodes (P < 0.001). At a median follow-up time of 6.3 years, there were no statistically significant differences in local recurrence (P = 0.11) or regional recurrence (P = 0.45) between the 2 groups. Despite the potential for residual axillary disease after SLND, SLND without ALND can offer excellent regional control and may be reasonable management for selected patients with early-stage breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.
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            Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review.

            Andrés J. Cortés, Fernando Lopez Prats, Pilar Alcorta … (2006)
            The purpose of our study was to evaluate the accuracy of sonography and sonographically guided biopsy in the preoperative diagnosis of metastatic invasion of the axilla in patients with breast carcinoma. We performed a MEDLINE search (keywords, "sonography" OR "ultrasound" AND "axillary") and a manual search of the references of relevant studies and reviews of preoperative diagnosis on sonography of possible axillary metastases. The gold standard required was axillary lymph node dissection; we accepted sentinel node biopsy as an alternative gold standard. Considering the sonographic findings and the results of the sonographically guided biopsy, the sensitivity and specificity were calculated using metaanalysis. We also checked the existence of heterogeneity of the summary results. Sixteen articles were selected. In sonography of axillae without palpable nodes, and using lymph node size as the criterion for positivity, sensitivity varied between 48.8% (95% confidence interval, 39.6-58%) and 87.1% (76.1-94.3%) and specificity, between 55.6% (44.7-66.3%) and 97.3% (86.1-99.9%). When lymph node morphology was used as the criterion for positivity, sensitivity ranged from 26.4% (15.3-40.3%) to 75.9% (56.4-89.7%) and specificity, from 88.4% (82.1-93.1%) to 98.1% (90.1-99.9%). The results are different if axillae with palpable nodes are included. The sonographically guided biopsy shows a sensitivity that varies between 30.6% (22.5-39.6%) and 62.9% (49.7-74.8%) and a specificity of 100% (94.8-100%). Many of the summary results obtained after meta-analysis show a heterogeneity that disappears, on occasion, on excluding the studies that use a double gold standard. Axillary sonography is moderately sensitive and fairly specific in the diagnosis of axillary metastatic involvement. Sonographically guided biopsy of the sonographically suspicious nodes somewhat increases the specificity, which reaches 100%. Negative sonographic results do not exclude axillary lymph node metastases.
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              TNM classification of malignant tumors. A comparison between the new (1987) and the old editions.

              P Hermanek, R Hutter, L Sobin (1988)
              A major revision of the tumor, nodes, metastasis (TNM) classification has been published. It eliminates previous differences between the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) versions. It also updates existing site classifications and adds chapters on previously unclassified tumors. This article summarizes the major changes from the past to the present editions of the TNM classification.
              Article 0 comments Cited 32 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Masakazu Urata: uray@m3.kufm.kagoshima-u.ac.jp
                Yuko Kijima: ykijima@m3.kufm.kagoshima-u.ac.jp
                Munetsugu Hirata: springai@m3.kufm.kagoshima-u.ac.jp
                Yoshiaki Shinden: shinden@m2.kufm.kagoshima-u.ac.jp
                Hideo Arima: arima@m.kufm.kagoshima-u.ac.jp
                Akihiro Nakajo: anakajo@m.kufm.kagoshima-u.ac.jp
                Chihaya Koriyama: fiy@m.kufm.kagoshima-u.ac.jp
                Takaaki Arigami: arigami@m.kufm.kagoshima-u.ac.jp
                Yoshikazu Uenosono: uenosono@m3.kufm.kagoshima-u.ac.jp
                Hiroshi Okumura: hokumura@m.kufm.kagoshima-u.ac.jp
                Kosei Maemura: kmaemura@m3.kufm.kagoshima-u.ac.jp
                Sumiya Ishigami: ishiga@m.kufm.kagoshima-u.ac.jp
                Heiji Yoshinaka: heiji@m3.kufm.kagoshima-u.ac.jp
                Shoji Natsugoe: natsugoe@m2.kufm.kagoshima-u.ac.jp
                Journal
                Journal ID (nlm-ta): BMC Cancer
                Journal ID (iso-abbrev): BMC Cancer
                Title: BMC Cancer
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2407
                Publication date (Electronic): 30 September 2014
                Publication date PMC-release: 30 September 2014
                Publication date Collection: 2014
                Volume: 14
                Issue: 1
                Electronic Location Identifier: 730
                Affiliations
                [ ]Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520 Japan
                [ ]Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
                Article
                Publisher ID: 4918
                DOI: 10.1186/1471-2407-14-730
                PMC ID: 4193134
                PubMed ID: 25266250
                SO-VID: 4e169549-2665-4e39-b40b-f3b4fd51c919
                Copyright © © Urata et al.; licensee BioMed Central Ltd. 2014
                License:

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 18 March 2014
                Date accepted : 26 September 2014
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2014

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer,computed tomography,hounsfield unit,lymph node metastasis,diagnosis,axillary lymph node
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: breast cancer, computed tomography, hounsfield unit, lymph node metastasis, diagnosis, axillary lymph node

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