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Journal of Ultrasound in Medicine, Vol 18, Issue 5 349-356, Copyright © 1999 by American Institute of Ultrasound in Medicine
In vitro B-mode ultrasonographic criteria for diagnosing axillary lymph node metastasis of breast cancer
T. Tateishi, J. Machi, E. J. Feleppa, R. Oishi, N. Furumoto, L. J. McCarthy, E. Yanagihara, S. Uchida, T. Noritomi and K. Shirouzu
Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine and Kuakini Medical Center, Honolulu 96814, USA.
Axillary lymph node status is an important factor for staging and treatment
planning in breast cancer. Our study was performed in vitro on a
node-by-node basis to evaluate the ability of B-mode ultrasonographic
images to distinguish metastatic from nonmetastatic nodes. Immediately
prior to histologic examination, individual dissected axillary nodes were
scanned in a water bath using a 10 MHz B-mode ultrasonographic transducer.
Four B-mode features (size, circularity, border demarcation, and internal
echo) were evaluated for their ability to distinguish metastatic from
nonmetastatic lymph nodes. Lymph node metastasis was indicated by (1) a
large size (i.e., a length of the longest axis of 10 mm or greater); (2) a
circular shape (i.e., the ratio of the shortest axis to the longest axis
between 0.5 and 1.0); (3) a sharply demarcated border compared with
surrounding fatty tissue; and (4) a hypoechoic internal echo, with
obliteration of the fatty hilum. The sensitivity and specificity were
compared for all combinations of features. We examined 84 histologically
characterized axillary nodes from 27 breast cancer patients, including 64
nonmetastatic and 20 metastatic nodes. Of the criteria cited, circular
shape was the best single feature for distinguishing metastatic from
nonmetastatic nodes (sensitivity, 65%; specificity, 73%). The best
combination of sensitivity (85%) and specificity (73%) was obtained using
the criterion that a lymph node contained cancer when at least three
positive features were present. The present in vitro study demonstrated
that the sensitivity and specificity of B-mode ultrasonography for
diagnosing lymph node metastasis were lower than 90%. Therefore, B-mode
ultrasonography may not be an optimal noninvasive screening method for
diagnosing axillary lymph node metastasis in breast cancer patients,
particularly under in vivo clinical conditions.
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