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Reducing unnecessary axillary lymph node biopsies using a quantitative ultrasound scoring system: analysis of 534
Erkan Bilgin1, Çetin İmamoglu2, Ahmet Bayrak2
1Radiology Department, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara. erk314@yahoo.com.
Aim:
Accurate assessment of axillary lymph nodes is crucial for breast cancer staging and clinical decision-making. This study evaluated the predictive value of quantitative morphologic ultrasound parameters and developed an objective scoring system to identify malignant axillary lymph nodes.
Materials And Methods:
This retrospective study included 534 axillary lymph nodes with histopathological confirmation. Quantitative sonographic parameters-cortical thickness, cortex-to-short-axis ratio (C/S), and short-to-long-axis ratio (S/L)-were measured. Diagnostic performance was assessed using ROC analysis, and optimal cut-off values were determined. Multivariable logistic regression identified independent predictors of malignancy. A practical points-based scoring system, informed by the multivariable model and ROC findings, was developed to support standardized biopsy decisions.
Results:
Cortical thickness showed the highest discriminative ability (AUC=0.883; optimal cut-off = 5.0 mm; sensitivity = 90.3%, specificity = 70.9%). In the combined model, cortical thickness, C/S ratio, S/L ratio, and age were independently associated with malignancy (p<0.001).
Conclusion:
Quantitative cortical morphologic parameters, particularly cortical thickness, are strong predictors of axillary lymph node malignancy. A multiparametric approach improves diagnostic accuracy and provides a more objective, reproducible method to guide biopsy decisions.
