Skip to main content

Advertisement

SpringerLink
Log in

Does BMI Affect the Accuracy of Preoperative Axillary Ultrasound in Breast Cancer Patients?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Obesity affects 36 % of American women and is a well-documented breast cancer risk factor. Preoperative axillary ultrasound (AUS) is used routinely for axillary staging in newly diagnosed breast cancer patients; However, the impact of obesity on the usefulness of AUS is unknown. Our aim was to evaluate the effect of body mass index (BMI) on the performance of AUS.

Methods

From our prospective breast surgery database, we identified 1,510 consecutive invasive breast cancers in patients undergoing primary surgery, including axillary operation, from January 2010 to July 2013. Preoperative AUS was performed in 1,375 cases (91 %). We analyzed patient, pathology and imaging data.

Results

Median BMI was 27.4 and 479 patients (36 %) were classified as obese (BMI ≥ 30). Most tumors were T1 (71 %) and estrogen receptor-positive (87 %). AUS was suspicious in 401 (29 %) patients, of whom 374 had ultrasound-guided lymph node fine-needle aspiration (FNA). Overall, 124 patients (33.2 %) were FNA positive. FNA identified disease preoperatively in 35.8 % of node-positive obese patients. For all BMI categories (normal, overweight, obese), AUS was predictive of pathologic nodal status (p < 0.0001). AUS sensitivity did not differ across BMI categories, while specificity and accuracy were better for overweight (p = 0.001 and 0.008, respectively) and obese (p = 0.007 and 0.02, respectively) patients, than for normal-BMI patients.

Conclusions

Despite theoretical concern regarding both potential technical challenges and obesity-related lymph node alterations, the sensitivity of preoperative AUS for detecting nodal metastasis was similar in obese and non-obese patients, while specificity was better in obese patients. Preoperative AUS is valuable for preoperative nodal staging of obese breast cancer patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235–241.

    Article  PubMed  CAS  Google Scholar 

  2. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491-497.

    Article  PubMed  Google Scholar 

  3. Kuczmarski RJ, Flegal KM. Criteria for definition of overweight in transition: background and recommendations for the United States. Am J Clin Nutr. 2000;72:1074–1081.

    PubMed  CAS  Google Scholar 

  4. van den Brandt PA, Spiegelman D, Yaun SS, et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. Am J Epidemiol. 2000;152:514–527.

    Article  PubMed  Google Scholar 

  5. Morimoto LM, White E, Chen Z, et al. Obesity, body size, and risk of postmenopausal breast cancer: the Women’s Health Initiative (United States). Cancer Causes Control. 2002;13:741–751.

    Article  PubMed  Google Scholar 

  6. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569–575.

    Article  PubMed  CAS  Google Scholar 

  7. Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14:297–305.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gentilini O, Veronesi U. Abandoning sentinel lymph node biopsy in early breast cancer? A new trial in progress at the European Institute of Oncology of Milan (SOUND: Sentinel node vs Observation after axillary UltraSouND). Breast. 2012;21:678–681.

    Article  PubMed  Google Scholar 

  9. Krishnamurthy S, Sneige N, Bedi DG, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. 2002;95:982–988.

    Article  PubMed  Google Scholar 

  10. Hieken TJ, Trull BC, Boughey JC, Jones KN, Reynolds CA, Glazebrook KG. Preoperative axillary imaging with percutaneous lymph node biopsy is valuable in the contemporary management of patients with breast cancer. Surgery. 2013;154:831–838; discussion 838–840.

    Article  PubMed  Google Scholar 

  11. Joh JE, Han G, Kiluk JV, Laronga C, Khakpour N, Lee MC. Indications for axillary ultrasound use in breast cancer patients. Clin Breast Cancer. 2012;12:433–437.

    Article  PubMed  Google Scholar 

  12. Hieken TJ, Boughey JC, Jones KN, Shah SS, Glazebrook KG. Imaging response and residual metastatic axillary lymph node disease after neoadjuvant chemotherapy for primary breast cancer. Ann Surg Oncol. 2013;20:3199–3204.

    Article  PubMed  Google Scholar 

  13. Houssami N, Diepstraten SC, Cody HS 3rd, Turner RM, Sever AR. Clinical utility of ultrasound-needle biopsy for preoperative staging of the axilla in invasive breast cancer. Anticancer Res. 2014;34:1087–1097.

    PubMed  Google Scholar 

  14. Sato K, Tamaki K, Tsuda H, Kosuda S, Kusano S, Hiraide H, et al. Utility of axillary ultrasound examination to select breast cancer patients suited for optimal sentinel node biopsy. Am J Surg. 2004;187:679–683.

    Article  PubMed  Google Scholar 

  15. Boughey JC, Moriarty JP, Degnim AC, Gregg MS, Egginton JS, Long KH. Cost modeling of preoperative axillary ultrasound and fine-needle aspiration to guide surgery for invasive breast cancer. Ann Surg Oncol. 2010;17:953–958.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Werbin N. Fatty changes and metastases in axillary lymph nodes. J Surg Oncol. 1984;25:145-147.

    Article  PubMed  CAS  Google Scholar 

  17. Stiffler KA, Jwayyed S, Wilber ST, Robinson A. The use of ultrasound to identify pertinent landmarks for lumbar puncture. Am J Emerg Med. 2007;25:331–334.

    Article  PubMed  Google Scholar 

  18. Giovagnorio F, Drudi FM, Fanelli G, Flecca D, Francioso A. Fatty changes as a misleading factor in the evaluation with ultrasound of superficial lymph nodes. Ultrasound Med Biol. 2005;31:1017–1022.

    Article  PubMed  Google Scholar 

  19. Misselt PN, Glazebrook KN, Reynolds C, Degnim AC, Morton MJ. Predictive value of sonographic features of extranodal extension in axillary lymph nodes. J Ultrasound Med. 2010;29:1705–1709.

    PubMed  Google Scholar 

  20. van Rijk MC, Deurloo EE, Nieweg OE, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 2006;13:31–35.

    Article  PubMed  Google Scholar 

  21. Garcia Fernandez A, Fraile M, Gimenez N, et al. Use of axillary ultrasound, ultrasound-fine needle aspiration biopsy and magnetic resonance imaging in the preoperative triage of breast cancer patients considered for sentinel node biopsy. Ultrasound Med Biol. 2011;37:16–22.

  22. Leenders MW, Broeders M, Croese C, et al. Ultrasound and fine needle aspiration cytology of axillary lymph nodes in breast cancer. To do or not to do? Breast. 2012;21:578–583.

    Article  PubMed  CAS  Google Scholar 

  23. Baruah BP, Goyal A, Young P, Douglas-Jones AG, Mansel RE. Axillary node staging by ultrasonography and fine-needle aspiration cytology in patients with breast cancer. Br J Surg. 2010;97:680–683.

    Article  PubMed  CAS  Google Scholar 

  24. Cools-Lartigue J, Sinclair A, Trabulsi N, Meguerditchian A, Mesurolle B, Fuhrer R, et al. Preoperative axillary ultrasound and fine-needle aspiration biopsy in the diagnosis of axillary metastases in patients with breast cancer: predictors of accuracy and future implications. Ann Surg Oncol. 2013;20:819–827.

    Article  PubMed  Google Scholar 

  25. Choi JS, Kim MJ, Moon HJ, Kim EK, Yoon JH. False negative results of preoperative axillary ultrasound in patients with invasive breast cancer: correlations with clinicopathologic findings. Ultrasound Med Biol. 2012;38:1881–1886.

    Article  PubMed  Google Scholar 

  26. Deglise C, Bouchardy C, Burri M, et al. Impact of obesity on diagnosis and treatment of breast cancer. Breast Cancer Res Treat. 2010;120:185–193.

    Article  PubMed  Google Scholar 

Download references

Disclosures

None

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    Anushi R. Shah MD, Judy C. Boughey MD, John R. Bergquist MD, Sean C. Dupont MD & Tina J. Hieken MD

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Katrina N. Glazebrook MD

  3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Tanya L. Hoskin MS

  4. Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA

    Sejal S. Shah MD

Authors
  1. Anushi R. Shah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katrina N. Glazebrook MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Judy C. Boughey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tanya L. Hoskin MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sejal S. Shah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John R. Bergquist MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sean C. Dupont MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tina J. Hieken MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tina J. Hieken MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shah, A.R., Glazebrook, K.N., Boughey, J.C. et al. Does BMI Affect the Accuracy of Preoperative Axillary Ultrasound in Breast Cancer Patients?. Ann Surg Oncol 21, 3278–3283 (2014). https://doi.org/10.1245/s10434-014-3902-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-3902-4

Keywords

Search

Navigation