Accuracy of Ultrasound Examination of Loco-Regional Lymph Nodes in Breast Cancer Follow-Up and Its Role in the Axillary Surgical Management


Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the accuracy of sonography in the diagnosis of loco-regional lymphatic recurrences in comparison to the core needle biopsy results. Materials and Methods: Among 6455 patients who were followed up with clinical examination, mammography and ultrasound between January 2004 and November 2011, 125 (1.93%) patients had to be investigated with a core needle biopsy of a sonographically suspicious loco-regional lymph node. Results: Among the whole series, a total of 142 ultrasound-guided core needle biopsies were performed. Follow-up for the primary tumor lasted for a median time of 6.1 years (range 1 - 27 years). Ultrasound of suspicious loco-regional lymph nodes showed a sensitivity of 89.5%, a specificity of 87.1% and a positive predictive value of 89.5%. Conclusions: In our experience, ultrasound of suspicious loco-regional lymph nodes showed good accuracy and it should be a part of the standard examinations performed during follow-up for breast cancer.

Share and Cite:

Nori, J. , Meattini, I. , Abdulcadir, D. , Giannotti, E. , Benedetto, D. , Sanchez, L. , Orzalesi, L. , Bianchi, S. , Capaccioli, L. and Livi, L. (2014) Accuracy of Ultrasound Examination of Loco-Regional Lymph Nodes in Breast Cancer Follow-Up and Its Role in the Axillary Surgical Management. Advances in Breast Cancer Research, 3, 5-11. doi: 10.4236/abcr.2014.31002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] H. Rauschecker, M. Clarke, W. Gatzemeier and A. Recht, “Systemic Therapy for Treating Locoregional Recurrence in Women with Breast Cancer,” Cochrane Database of Systematic Reviews, 2001, CD002195.
[2] F. Aydogan, V. Ozben, D. Atasoy, M. H. Yilmaz, M. Hala? and V. Celik, “Excision of Axillary Lymph Node Recurrences in Breast Cancer Patients with Axillary ROLL (A-ROLL),” Journal of Surgical Oncology, Vol. 101, No. 2, 2010, pp. 141-144.
[3] H. J. Kim, J. Y. Kwak, J. W. Choi, et al., “Impact of US Surveillance on Detection of Clinically Occult Locoregional Recurrence after Mastectomy for Breast Cancer,” Annals of Surgical Oncology, Vol. 17, No. 10, 2010, pp. 2670-2676.
[4] S. Aebi, T. Davidson, G. Gruber, F. Cardoso and ESMO Guidelines Working Group, “Primary Breast Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up,” Annals of Oncology, Vol. 22, Suppl. 6, 2011, pp. S12-S24.
[5] H. Torrenga, H. Fabry, J. R. van der Sijp, P. J. van Diest, R. Pijpers and S. Meijer, “Omitting Axillary Lymph Node Dissection in Sentinel Node Negative Breast Cancer Patients Is Safe: A Long Term Follow-Up Analysis,” Journal of Surgical Oncology, Vol. 88, No. 1, 2004, pp. 4-7.
[6] L. Sobin, M. Gospodarowicz and C. Wittekind, Eds., “UICC TNM Classification of Malignant Tumors,” 7th Edition, John Wiley & Sons, Inc., Hoboken, 2009.
[7] N. M. Perry and EUSOMA Working Party, “Quality Assurance in the Diagnosis of Breast Disease. EUSOMA Working Party,” European Journal of Cancer, Vol. 37, No. 2, 2001, pp. 159-172.
[8] H. Ojeda-Fournier and J. Q. Nguyen, “Ultrasound Evaluation of Regional Breast Lymph Node,” Seminars in Roentgenology, Vol. 46, No. 1, 2011, pp. 51-59. 06.007
[9] F. Sakai, K. Kiyono, S. Sone, et al., “Ultrasonic Evaluation of Cervical Metastatic Lymphadenopathy,” Journal of Ultrasound in Medicine, Vol. 7, No. 6, 1988, pp. 305-310.
[10] A. Luparia, P. Campanino, R. Cotti, et al., “Role of Axillary Ultrasound in the Preoperative Diagnosis of Lymph Node Metastases in Patients Affected by Breast Carcinoma,” Radiologia Medica, Vol. 115, No. 2, 2010, pp. 225-237.
[11] J. Nori, E. Vanzi, M. Bazzocchi, et al., “Role of Axillary Ultrasound Examination in the Selection of Breast Cancer Patients for Sentinel Node Biopsy,” American Journal of Surgery, Vol. 193, No. 6, 2007, pp. 16-20.
[12] S. Alvarez, E. Anorbe, P. Alcorta, et al., “Role of Sonography in the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review,” American Journal of Roentgenology, Vol. 186, No. 5, 2006, pp. 1342-1348.
[13] J. H. Shin, B. K. Han, Y. H. Choe, et al., “Ultrasonographic Detection of Occult Cancer in Patients after Surgical Therapy for Breast Cancer,” Journal of Ultrasound in Medicine, Vol. 24, No. 5, 2005, pp. 643-649.
[14] T. Susini, J. Nori, E. Vanzi, et al., “Axillary Ultrasound Scanning in the Follow-Up of Breast Cancer Patients Undergoing Sentinel Node Biopsy,” Breast, Vol. 16, No. 2, 2007, pp. 190-196.
[15] H. J. Moon, M. J. Kim, E. K. Kim, et al., “US Surveillance of Regional Lymph Node Recurrence after Breast Cancer Surgery,” Radiology, Vol. 252, No. 3, 2009, pp. 673-681. 1148/radiol.2523081977
[16] J. H. Lee, E. K. Kim, J. Y. Oh, et al., “US Screening for Detection of Nonpalpable Locoregional Recurrence after Mastectomy,” European Journal of Radiology, Vol. 82, No. 3, 2013, pp. 485-489.
[17] H. Abe, R. A. Schmidt, K. Kulkarni, C. A. Sennett, J. S. Mueller and G. M. Newstead, “Axillary Lymph Nodes Suspicious for Breast Cancer Metastasis: Sampling with US-Guided 14-Gauge Core-Needle Biopsy—Clinical Experience in 100 Patients,” Radiology, Vol. 250, No. 1, 2009, pp. 41-49.
[18] H. Abe, R. A. Schmidt, C. A. Sennett, A. Shimauchi and G. M. Newstead, “US-Guided Core Needle Biopsy of Axillary Lymph Nodes in Patients with Breast Cancer: Why and How to Do It,” Radiographics, Vol. 27, Suppl. 1, 2007, pp. S91-S99.
[19] S. L. Koelliker, M. A. Chung, M. Mainiero, et al., “Axillary Lymph Nodes: US-Guided Fine-Needle Aspiration for Initial Staging of Breast Cancer—Correlation with Primary Tumor Size,” Radiology, Vol. 246, No. 1, 2008, pp. 81-89.
[20] S. Wojcinski, A. Farrokh, U. Hille, et al., “Optimizing Breast Cancer Follow-Up: Diagnostic Value and Costs of Additional Routine Breast Ultrasound,” Ultrasound in Medicine and Biology, Vol. 37, No. 2, 2011, pp. 198-206.
[21] U. Veronesi, R. Orecchia, S. Zurrida, et al., “Avoiding Axillary Dissection in Breast Cancer Surgery: A Randomized Trial to Assess the Role of Axillary Radiotherapy,” Annals of Oncology, Vol. 16, No. 3, 2005, pp. 383-388.
[22] I. M. Van der Ploeg, B. B. Kroon, N. Antonini, et al., “Axillary and Extra-Axillary Lymph Node Recurrences after a Tumor-Negative Sentinel Node Biopsy for Breast Cancer Using Intralesional Tracer Administration,” Annals of Surgical Oncology, Vol. 15, No. 4, 2008, pp. 1025-1031.
[23] A. E. Giuliano, L. McCall, P. Beitsch, et al., “Locoregional Recurrence after Sentinel Lymph Node Dissection with or without Axillary Dissection in Patients with Sentinel Lymph Node Metastases: The American College of Surgeons Oncology Group Z0011 Randomized Trial,” Annals of Surgery, Vol. 252, No. 3, 2010, pp. 426-432.
[24] I. M. Van der Ploeg, O. E. Nieweg, M. C. van Rijk, et al., “Axillary Recurrence after a Tumour-Negative Sentinel Node Biopsy in Breast Cancer Patients: A Systematic Review and Meta-Analysis of the Literature,” European Journal of Surgical Oncology, Vol. 34, No. 12, 2008, pp. 1277-1284.
[25] H. Takei, K. Suemasu, M. Kurosumi, et al., “Recurrence after Sentinel Lymph Node Biopsy with or without Axillary Lymph Node Dissection in Patients with Breast Cancer,” Breast Cancer, Vol. 14, No. 1, 2007, pp. 16-24.
[26] U. Veronesi, V. Galimberti, G. Paganelli, et al., “Axillary Metastases in Breast Cancer Patients with Negative Sentinel Nodes: A Follow-Up of 3548 Cases,” European Journal of Cancer, Vol. 45, No. 8, 2009, pp. 1381-1388.
[27] S. Bernardi, S. Bertozzi, A. P. Londero, et al., “Nine Years of Experience with the Sentinel Lymph Node Biopsy in a Single Italian Center: A Retrospective Analysis of 1050 Cases,” World Journal of Surgery, Vol. 36, No. 4, 2012, pp. 714-722.
[28] A. E. Giuliano, K. K. Hunt, K. V. Ballman, et al., “Axillary Dissection vs No Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial,” JAMA, Vol. 305, No. 6, 2011, pp. 569-575.
[29] V. Galimberti, E. Botteri, C. Chifu, et al., “Can We Avoid Axillary Dissection in the Micrometastatic Sentinel Node in Breast Cancer?” Breast Cancer Research and Treatment, Vol. 131, No. 3, 2012, pp. 819-825.
[30] V. Galimberti, B. F. Cole, S. Zurrida, et al., “Axillary Dissection versus No Axillary Dissection in Patients with Sentinel-Node Micrometastases (IBCSG 23-01): A Phase 3 Randomised Controlled Trial,” Lancet Oncology, Vol. 14, No. 4, 2013, pp. 297-305.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.