Abstract | April 5, 2022

Ultrasound Findings of Pre-Dissection Axillary Lymph Nodes in Breast Cancer Patients

Presenting Authors: Ruby Arora, BA, Medical Student, 2nd Year, Tulane University School of Medicine, New Orleans, LA; Lauren Mueller, BS, Medical Student, Tulane University School of Medicine, New Orleans, LA

Coauthors: Ruby Arora, BA, Medical Student, Tulane University School of Medicine, New Orleans, LA; Lauren Mueller, BS, Medical Student, Tulane University School of Medicine, New Orleans, LA; Samantha A. Lapayowker, BS, Medical Student, Tulane University School of Medicine, New Orleans, LA; Judy N. Fustok, JD, Medical Student, Tulane University School of Medicine, New Orleans, LA; Cynthia W. Hanemann, MD, Vice Chairman, Department of Radiology, Tulane University School of Medicine, New Orleans, LA.

Learning Objectives

  1. Discuss how certain ultrasound characteristics are associated with TMN staging in breast cancer patients.

Background/Knowledge Gap: Axillary lymph node status is an important predictor of prognosis in breast cancer patients. While sentinel lymph node biopsy (SLNB) can predict axillary lymph node metastasis, it can result in many different complications1. Ultrasound is a quick and low-cost imaging modality that is commonly used to image the breasts. Literature has shown that ultrasound findings such as tumor shape and high color Doppler flow imaging grades were significantly related to axillary lymph node metastasis in breast cancer patients1. Our study aims to analyze the association between pre-dissection ultrasound reports of axillary lymph nodes and post-axillary lymph node excision pathology reports. We will also analyze what changes on ultrasound are associated with metastatic breast cancer and how our population might differ from the current literature.

Methods/Design: We will retrospectively analyze patients who are registered in the Tulane Breast Cancer Registry. Patients who are female, above the age of 18, not pregnant, underwent ultrasound of their axillary lymph node before dissection of their axillary lymph node and received pathologic analysis of their axillary lymph nodes will be included as subjects. We will obtain the following data: patient’s age, gender, ethnicity, axillary lymph node ultrasound findings, post-dissection axillary lymph node pathologic findings, breast cancer staging at time of diagnosis. With our data, we will perform a chisquared statistical analysis to determine if a statistically significant relationship exists between ultrasound findings and pathology reports.

Results/Findings: We will compare the axillary lymph node ultrasound findings to the axillary lymph node post-dissection pathology report. We predict that certain ultrasound characteristics such as cortical thickening, loss of reniform shape, and effacement of the fatty hilum will be associated with TMN staging and isolated cancer cells within the dissected axillary lymph nodes. We will also compare our findings to the current literature to understand if our patient population may differ.

Conclusions/Implications: We will describe how certain ultrasound characteristics of the pre-dissected axillary lymph nodes are associated with final pathology reports of post-axillary dissection. Understanding axillary lymph node biopsy characteristics pertaining to final pathologic analysis may provide clinicians with predictive factors regarding breast cancer metastasis and prognosis.

References and Resources:

  1. Guo Q, Dong Z, Zhang L, Ning C, Li Z, Wang D, Liu C, Zhao M, Tian J. Ultrasound Features of Breast Cancer for Predicting Axillary Lymph Node Metastasis. J Ultrasound Med. 2018 Jun;37(6):1354-1353. doi: 10.1002/jum.14469. Epub 2017 Nov 9. PMID: 29119589.
  2. Sun SX, Moseley TW, Kuerer HM, Yang WT. Imaging-Based Approach to Axillary Lymph Node Staging and Sentinel Lymph Node Biopsy in Patients With Breast Cancer. AJR Am J Roentgenol. 2020 Feb;214(2):249- 258. doi: 10.2214/AJR.19.22022. Epub 2019 Nov 12. PMID: 31714846.
Posted in: Women’s & Children’s Health27