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US surveillance of regional lymph node recurrence after breast cancer surgery.

 Hee Jung Moon  ;  Min Jung Kim  ;  Eun-Kyung Kim  ;  Byeong-Woo Park  ;  Ji Hyun Youk  ;  Jin Young Kwak  ;  Joohyuk Sohn  ;  Seung-Il Kim 
 RADIOLOGY, Vol.252(3) : 673-681, 2009 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; Breast Neoplasms/mortality ; Breast Neoplasms/pathology* ; Breast Neoplasms/surgery* ; Chi-Square Distribution ; Female ; Humans ; Lymph Nodes/diagnostic imaging* ; Lymph Nodes/pathology ; Lymphatic Metastasis/diagnostic imaging* ; Lymphatic Metastasis/pathology ; Middle Aged ; Neoplasm Recurrence, Local/diagnostic imaging* ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/pathology ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Statistics, Nonparametric ; Ultrasonography, Interventional ; Ultrasonography, Mammary
PURPOSE: To determine the diagnostic indexes of lymph node ultrasonography (US) of the axillary and supraclavicular regions for detecting lymph node recurrence (LNR) after breast cancer surgery and assess the effect of lymph node evaluation on prognosis during bilateral breast US. MATERIALS AND METHODS: Institutional review board approved this retrospective study and waived informed consent. Between January 2003 and December 2004, 3982 lymph node US examinations, including bilateral axillary and supraclavicular areas, were performed in 1817 women (mean age, 49.9 years; range, 22-86 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 US. Diagnostic indexes of US for detecting LNR were assessed. The frequency of distant metastases between patients with ipsilateral LNR and those without was compared. Three-year mortality rates of patients with ipsilateral LNR only and those with distant metastases were evaluated. RESULTS: Of 1817 patients, 54 had suspicious LNR at US (28 at first, 20 at second, five at third, and one at fourth US examination). Thirty-nine of 1817 patients (2.1%), including nine with palpable lesions, had LNR, 11 of whom had ipsilateral LNR only. At first lymph node US, LNR was detected in 17 patients; at second, in 10; at third, in two; and at fourth, in one. Nine had false-negative results. The respective sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of lymph node US for detecting LNR per woman was 76.9% (30 of 39), 98.7% (1754 of 1778), 98.2% (1784 of 1817), 55.6% (30 of 54), and 99.5% (1754 of 1763); those of first lymph node US were 85.0% (17 of 20), 99.4% (1786 of 1797), 99.2% (1803 of 1817), 60.7% (17 of 28), and 99.8% (1786 of 1789); and those of total US examinations were 78.0% (32 of 41), 99.4% (3917 of 3941), 99.2% (3949 of 3982), 57.1% (32 of 56), and 99.8% (3917 of 3926). Distant metastases were found more frequently in patients with ipsilateral LNR (62%) than in those without (2.3%) (P < .0001). The 3-year mortality rate of patients with ipsilateral LNR only was significantly lower than that in patients with distant metastases (P = .03). CONCLUSION: Ipsilateral LNR is a predictor of distant metastasis, and lymph node evaluation during breast US is useful for early detection of LNR in asymptomatic patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0003-4949-1237
Kim, Seung Il(김승일)
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Park, Byeong Woo(박병우) ORCID logo https://orcid.org/0000-0003-1353-2607
Sohn, Joo Hyuk(손주혁) ORCID logo https://orcid.org/0000-0002-2303-2764
Youk, Ji Hyun(육지현) ORCID logo https://orcid.org/0000-0002-7787-780X
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