J Breast Cancer.  2012 Mar;15(1):65-70. 10.4048/jbc.2012.15.1.65.

Classification of Metastatic versus Non-Metastatic Axillary Nodes in Breast Cancer Patients: Value of Cortex-Hilum Area Ratio with Ultrasound

Affiliations
  • 1Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea. seoboky@korea.ac.kr
  • 2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
  • 4Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
To investigate the significance of the cortex-hilum (CH) area ratio and longitudinal-transverse (LT) axis ratio and the blood flow pattern for diagnosis of metastatic axillary lymph nodes by ultrasound in breast cancer patients.
METHODS
From October 2005 to July 2006, we prospectively evaluated axillary nodes with ultrasound in 205 consecutive patients who had category 4B, 4C or 5 breast lesions according to the Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-Ultrasound(R)). Among the 205, there were 24 patients who had pathologic verification of breast cancer and axillary lymph node status. For a total of 80 axillary nodes we measured the areas of the cortex and hilum of lymph nodes and calculated the area ratio. We also measured the length of the longitudinal and transverse axis of the lymph nodes and calculated the length ratio. We evaluated the blood flow pattern on power Doppler imaging and classified each lymph node into a central or peripheral pattern. Diagnostic performance was analyzed according to positive criteria for lymph node metastasis (CH area ratio >2, LT axis ratio <2, peripheral type on power Doppler imaging).
RESULTS
The sensitivity of the CH area ratio was superior to that of the LT axis ratio (94.1% vs. 82.3%, p=0.031) and to that of the blood flow pattern (94.1% vs. 29.4%, p=0.009). For specificity, all three evaluating parameters had high values (89.1-95.6%) and no significant differences were found (p=0.121). The CH area ratio had a better positive predictive value than the LT axis ratio (94.1% vs. 80.0%, p=0.030) and power Doppler imaging (94.1% vs. 66.6%, p=0.028). For the negative predictive value, the CH area ratio was superior to the LT axis ratio (95.6% vs. 86.6%, p=0.035) and the blood flow pattern (95.6% vs. 63.0%, p=0.027).
CONCLUSION
We recommend the CH area ratio of an axillary lymph node on ultrasound as a quantitative indicator for the classification of lymph nodes. The CH area ratio can improve diagnostic performance when compared with the LT axis ratio or blood flow pattern.

Keyword

Breast; Lymph nodes; Lymphatic metastasis; Ultrasonography

MeSH Terms

Axis, Cervical Vertebra
Breast
Breast Neoplasms
Humans
Lymph Nodes
Lymphatic Metastasis
Neoplasm Metastasis
Prospective Studies
Sensitivity and Specificity

Figure

  • Figure 1 Drawings illustrate how to obtain cortex-hilum area ratios and longitudinal-transverse axis ratios of a lymph node on gray-scale ultrasound imaging. (A) We traced the outer margins of hypoechoic cortex and hyperechoic hilum of a lymph node and obtained areas (cm2) of each site at the section of the maximum size of a lymph node. And then we calculated the cortex-hilum area ratio. (B) We measured lengths (cm) of longitudinal and transverse diameters at the section of the maximum size of a lymph node and then calculated the longitudinal-transverse axis ratio.

  • Figure 2 Drawings illustrate how to classify the blood flow pattern of a lymph node on power Doppler imaging. We evaluated vascular predominance in peripheral or central portions of a lymph node and then divided into peripheral (A) or central (B) types. If a node had no vascularity, we classified it as having no blood flow.

  • Figure 3 A 32-year-old woman with invasive ductal carcinoma with positive lymph node metastasis. (A) A lymph node (arrows) is seen on ultrasound (US). (B) The cortex-hilum area ratio was 11.6 and the longitudinal-transverse axis ratio was 3.09. (C) Power Doppler US shows a central type of blood flow.

  • Figure 4 A 39-year-old woman with invasive ductal carcinoma with positive lymph node metastasis. (A) A lymph node (arrows) is seen on ultrasound (US). (B) The cortex-hilum area ratio was 3.60 and the longitudinal-transverse axis ratio was 2.68. (C) On power Doppler US, there was no blood flow.


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