EP22.22: Breast and axillary lymph node ultrasound features useful for the preoperative prediction of axillary metastases

This study aims to analyse the clinical value of ultrasound features of breast lesions and axillary lymph nodes for predicting the risk of nodal metastases in patients with breast cancer. We evaluated the size concordance between ultrasound and histological examination. In this retro- and prospective study 85 patients with breast cancer surgery in 1st Clinic of Gynecology Iasi, Romania were recruited from January 2019 - June 2022, and their ultrasound features and pathologic results were collected. For axillary lymph nodes the cortex thickening, hilum aspect, and contour were evaluated. We considered the largest tumour and lymph node dimensions. We correlated the ultrasound features of the breast tumour with axillary metastases. The mean age of the study group was 56.82 years ± 13.86 years (30 -84 years). 34 women (39.08%) had axillary lymph node metastases at the pathological examination. The correlation between ultrasound and histological tumour size is direct, moderate in intensity, and statistically significant (r=+0.48; p = 0.001). The analysis of tumour ultrasound parameters indicated that the tumour contour (p = 0.178), imprecise margins (p = 0.215), orientation (p = 0.819), echogenicity (p = 0.456), posterior acoustic shadow (p = 0.839), surrounding tissue appearance (p = 0.355), calcifications (p = 0.382), distribution of vessels (p = 0.290), and perilesional edema (p = 0.302) had no statistical significance for the lymph node metastases. Only the tumour vascular score (p = 0.02) and the distance between the tumour and the skin (p = 0.019) were predictive of lymph node metastases. Axillary nodes evaluation is useful in estimating metastases (absence of the hilum fat p = 0.000, hypoechoic aspect p = 0.000, and blurry contour of the node p = 0.017). The ultrasound features of breast cancer and axillary lymph nodes seem to be promising tools in predicting nodal metastases, as well as for informing patients about the type of surgical intervention proposed.