Radiology: Ultrasound predicts distant metastases after breast cancer surgery
Distant metastases are found more frequently in patients with ipsilateral lymph node recurrence, and researchers advise that the axillary and supraclavicular node areas be included in ultrasound screening after breast cancer surgery, according to a study in this month’s Radiology.

Hee Jung Moon, MD, from the department of radiology of the Research Institute of Radiological Science at the Yonsei University College of Medicine in Seoul, South Korea, and colleagues sought to determine the diagnostic indexes of lymph node ultrasonography of the axillary and supraclavicular regions for detecting lymph node recurrence (LNR) after breast cancer surgery, as well as assess the effect of lymph node evaluation on prognosis during bilateral breast ultrasound.

Between January 2003 and December 2004, the researchers performed 3,982 lymph node ultrasound exams, including bilateral axillary and supraclavicular areas, in 1,817 women (mean age, 49.9 years) after breast cancer surgery, nine of whom had palpable lesions. Final diagnosis was based on cytopathologic results, clinical follow up and imaging studies for at least 12 months after breast ultrasound. They assessed diagnostic indexes of ultrasound for detecting LNR.

Of 1,817 patients, 54 had suspicious LNR (28 at first, 20 at second, five at third and one at fourth ultrasound exam). The authors found that 2.1 percent--including nine with palpable lesions--had LNR, 11 of whom had ipsilateral LNR only. At first lymph node ultrasound, LNR was detected in 17 patients; at second, in 10; at third, in two; and at fourth, in one. Nine had false-negative results.

According to the authors, the respective sensitivity, specificity, accuracy, positive predictive value and negative predictive value of lymph node ultrasound for detecting LNR per woman was 76.9 percent, 98.7 percent, 98.2 percent, 55.6 percent and 99.5 percent; those of first lymph node ultrasound were 85 percent, 99.4 percent, 99.2 percent, 60.7 percent and 99.8 percent; and those of total ultrasound exams were 78 percent, 99.4 percent, 99.2 percent, 57.1 percent and 99.8 percent.

Distant metastases were found more frequently in patients with ipsilateral LNR (62 percent) than in those without (2.3 percent), the researchers said. They also found that the three-year mortality rate of patients with ipsilateral LNR only was significantly lower than that in patients with distant metastases

Based on their results, Moon and colleagues concluded that the ipsilateral LNR is a predictor of distant metastasis, and lymph node evaluation during breast ultrasound is useful for early detection of LNR in asymptomatic patients.