Modern view on the issues of diagnosis and verification of axillary lymph nodes involvement in early breast cancer

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Abstract

The involvement of axillary lymph nodes is one of the most important prognostic factors, significantly affecting the treatment strategy for early breast cancer (BC). The risk of axillary lymph node metastases depends directly on a number of factors (age of women, size of tumor, presence of lymphovascular invasion and biological characteristics of cancer). The evaluation of regional lymph node status in patients with early BC includes the clinical examination of regional zones and the ultrasound study (US), using these methods can help to study lymph nodes shape, borders, margins and structure. The sensitivity of ultrasound in the evaluation of regional lymph nodes status directly depends on the biological subtype of the tumor; the minimum level of ultrasound sensitivity in the evaluation of lymph nodes status is detected for luminal HER2-negative cancer (less than 40%), and maximum sensitivity is detected for triple negative and HER2-positive subtypes (68–71%). Clinical examination and modern ultrasound are the most accessible methods for the evaluation of regional lymph nodes status, but the possibility to misjudge metastatic process can be detected in 1/4 of patients. Verification of the diagnosis in the preoperative phase (fine-needle aspiration biopsy/core-needle biopsy under ultrasound guidance) allows minimize the number of errors for the regional staging. The sentinel lymph node biopsy (SLNB) is the «gold standard» of regional treatment in patients with early stage BC, nowadays. The randomized trials (NSABP B-32, ACOSOG q0011) show the safety of recession of performing regional lymph node dissection in favor of SLNB not only in case of clinically negative lymph nodes, but also in patients with metastases in ≤2 sentinel lymph nodes, upon condition that organ-conservative treatment and subsequent radiation therapy will be used. High-quality regional staging, the choice of the therapeutic algorithm in accordance with the biological characteristics of carcinoma, the application of the most effective modern drug regimes, the optimal radiation therapy allow not only minimize the extent of surgery, but also achieve high long-term survival results, provide excellent functional results and high quality of life in patients with the involvement of axillary lymph nodes.

About the authors

Irina V. Kolyadina

Russian Medical Academy of Continuous Professional Education; Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Author for correspondence.
Email: irinakolyadina@yandex.ru
ORCID iD: 0000-0002-1124-6802

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Tatiana Yu. Danzanova

Blokhin National Medical Research Center of Oncology

Email: danzanova@yandex.ru
ORCID iD: 0000-0002-6171-6796

D. Sci. (Med.)

Russian Federation, Moscow

Svetlana V. Khokhlova

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: svkhokhlova@mail.ru

D. Sci. (Med.)

Russian Federation, Moscow

Oksana P. Trofimova

Russian Medical Academy of Continuous Professional Education; Blokhin National Medical Research Center of Oncology

Email: dr.trofimova@mail.ru

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Ekaterina V. Kovaleva

Blokhin National Medical Research Center of Oncology

Email: dr.trofimova@mail.ru

Graduate Student

Russian Federation, Moscow

Valerii V. Rodionov

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: dr.valery.rodionov@gmail.com

D. Sci. (Med.)

Russian Federation, Moscow

Irina V. Poddubnaya

Russian Medical Academy of Continuous Professional Education

Email: poddubnaya_irina@inbox.ru
ORCID iD: 0000-0002-0995-1801

Acad. RAS, D. Sci. (Med.), Prof.

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. B-mode ultrasound images of regional lymph node metastases: a – abnormal supraclavicular lymph node with an irregular shape; b – abnormal round axillary lymph node.

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3. Fig. 2. B-mode ultrasound image of metastatic axillary lymph node: diffuse thickening of the cortex and cortical bulging of a separate part.

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4. Fig. 3. B-mode: metastatic axillary lymph node calcification.

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5. Fig. 4. Color Doppler Energy Mapping of metastatic axillary lymph node.

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6. Fig. 5. Strain elastography of lymph nodes: a – metastatic lymph node with heterogeneous hardness (elastographic pattern 3); b – hyperplastic lymph node (elastographic pattern 1).

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7. Fig. 6. Contrast-enhanced ultrasound of lymph node metastasis in BC: inhomogeneous enhancement due to perfusion defects.

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