Purpose: The aim of our study was to evaluate the diagnostic value of gray-scale ultrasonography and color Doppler flow for the detection of axillary lymph node metastases in breast cancer patients.
Methods: This prospective study included 98 women (39 healthy women and 59 with approved diagnosis of breast cancer). All women underwent examination of gray-scale ultrasonography and color Doppler flow. Morphological lymph node findings, intranodal flow distribution and quantitative blood flow parameters were documented and analyzed. Patients were arranged by ultrasound examination findings in to two groups. First group (experimental (n=29)) – women, who was noticed with abnormal axillary lymph nodes during the ultrasound examination. Second group (control (n=69)) – women, who had normal axillary lymph nodes during the ultrasound examination. Healthy women were repeatedly examined after 3 and 6 months. Women who were diagnosed with breast cancer underwent sentinel lymph node biopsy, ultrasound examination findings were compared with histological sample findings. Metastases in the axillary lymph nodes were diagnosed for 22 patients. The accuracy, sensitivity and specificity of ultrasound analysis were calculated.
Results: Cortical thickening was found in malignant lymph nodes – 4,3mm, in benign lymph nodes – 2,2mm (p<0,001). Benign lymph nodes had significantly greater central flow, while malignant lymph nodes had peripheral flow (p<0,05). Kinetic findings: benign axillary lymph nodes RI=0,59±0,2, PI=3,06±2,4, DSG=5,34±2,1, MDG=2,53±1,6; malignant lymph nodes RI=0,78±0,2, PI=7,91±4,2, DSG=5,89±1,5, MDG=2,24±1,4, but there was no significant meaning (p>0,05). Evaluating just morphological findings, ultrasound analysis’ accuracy is 81,4%, sensitivity 90,9%, specificity 75,7%, but combined together with kinetic findings accuracy 88,1-89,8%, sensitivity 95,8-96%, specificity 82,9-85,3%.
Conclusions: Cortex thickness and peripheral flow was statistically significant findings in diagnosing metastasis in axillary lymph nodes. Malignant lymph nodes RI and PI usually have greater value than benign lymph nodes, but there was no significant meaning, therefore we cannot depend only on kinetic findings of a lymph node blood flow. Examining kinetic and morphological lymph node findings together gives us 7% more accurate ultrasound analysis.
Keywords: doppler ultrasonography (DUS), malignant axillary lymph nodes, peak systolic velocity (DSG), pulsatility index (PI), resistive index (RI).