Effect, sensitivity, specificity and accuracy of ultrasonic assessment of axillary lymph node-negative breast cancer

Abstract

Objective: To investigate the diagnostic value of ultrasound for patients with axillary lymph node-negative breast cancer (ALNNBC).

Methods: A retrospective analysis was performed on the clinical data of 204 breast cancer patients who were admitted by Quanzhou First Hospital Affiliated to Fujian Medical University between October 2020 and May 2022. According to the results of axillary lymph node (ALN) examination, the patients were assigned to a positive group(n=102) and a negative group(n=102). All patients underwent diagnosis with color Doppler ultrasound, with pathological diagnosis as the "gold standard" to determine the sensitivity and specificity of ultrasonic diagnosis. A receiver operating characteristic(ROC) curve was established to analyze the efficiency of ultrasonic diagnosis and compare the ultrasonographic features and flow grades between the two groups.

Results: Differences were statistically significant between the two groups in ultrasonographic features of lesions(negative vs positive, all p<0.05), including morphological irregularity(59.8% vs 85.3%), spiky margins(19.6% vs 63.7%), posterior echo attenuation(19.6% vs 44.1%) and microcalcification(40.2% vs 55.89%). The negative group had a lower proportion of patients with grade 2-3 ultrasound blood flow when compared with the positive group(32.4% vs 56.86%), and the difference was statistically significant(p<0.05). Ultrasonic diagnosis of ALNNBC had a sensitivity of 88.24%(90/102), a specificity of 92.16%(94/102), a coincidence rate of 90.20% (184/204), a 95% CI of 0.845-0.928, and an AUC of 0.879.

Conclusions: Ultrasonic diagnosis of ALNNBC is relatively efficient as ultrasonographic features and ultrasound blood flow signals can provide a scientific basis for the diagnosis of ALNNBC.

Keywords: Axillary Lymph Node (ALN); Breast cancer; Color Doppler ultrasound; Sensitivity; Specificity.

Fig.1

Typical ultrasound blood flows Left: early-stage infiltrating breast cancer, ALN-negative, 30-year-old, with a disease course of 3 months, grade-2 flow signals primarily distributed in the tissue surrounding the tumor and the intralesional streak-like hyperechoic area. Right: mid- to late-stage infiltrating breast cancer, ALN-positive, 36-year-old, with a disease course of 23 months, grade-3 flow signals mainly distributed in the intralesional solid hypoechoic area.