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Ultrasonographic Evaluation of Breast Cancer-related Lymphedema
Published on: January 12, 2017
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A Validated Ultrasound-Based Scoring System to Stratify Risk of Axillary Metastasis in Breast Cancer: AX-RADS
Spencer G Van Decar1, Elizabeth L Barbera1, Alexandra M Adams1
1Brooke Army Medical Center, San Antonio, Texas, USA.
Journal of Surgical Oncology
|May 20, 2025
Summary
This study developed an ultrasound scoring system to predict axillary lymph node metastasis (ALNM) in breast cancer patients. The system effectively quantifies ALNM risk, aiding treatment decisions for breast cancer management.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Breast cancer diagnosis relies on ultrasound for axillary involvement, but its accuracy varies.
- Accurate assessment of axillary lymph node metastasis (ALNM) risk is crucial for guiding breast cancer treatment decisions.
- Existing methods for evaluating axillary involvement in breast cancer lack consistent sensitivity and specificity.
Purpose of the Study:
- To develop and validate a scoring system to quantify the risk of axillary lymph node metastasis (ALNM) using ultrasound characteristics in breast cancer patients.
- To create a tool that aids in predicting ALNM risk based on imaging findings.
- To integrate ultrasound-based risk assessment with established nomograms for improved treatment planning.
Main Methods:
- A scoring system was developed using regression coefficients from variables significantly predicting ALNM in a single-institution cohort (2019-2021).
- The scoring system's predictive performance was validated at an external institution.
- A combined cohort of 358 patients was stratified based on predicted ALNM positivity using a validated nomogram.
Main Results:
- The developed axillary ultrasound scoring system demonstrated a Negative Predictive Value (NPV) of 84% and a Positive Predictive Value (PPV) of 85% in the combined cohort.
- In low-risk groups (score 0-1), the NPV was 87% (validation) and 84% (combined).
- In high-risk groups (score 5+), the PPV was 71% (validation) and 85% (combined), with improved PPV (82%) when combined with the MSK nomogram for high-risk predictions.
Conclusions:
- A novel scoring system based on axillary ultrasound characteristics was successfully developed to predict ALNM in breast cancer patients undergoing upfront surgery.
- This ultrasound scoring system, when combined with established nomograms, can enhance communication regarding ALNM risk.
- The integrated approach aids in making more informed and personalized treatment decisions for breast cancer patients.
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