Evaluation of axillary lymph node status with mammography, usg and mri in breast cancer cases, comparison of these results with intraoperative slnb and postoperative pathology results

One of the most common malignancies in women is breast cancer. Evaluation of the axilla in these patients has a substantial place in terms of prognosis of the disease, surgical treatment plan and adjuvant treatment. Mammography, USG and MRI can be used for preoperative radiological staging of the axilla. SLNB and ALND are performed for the purpose of pathological staging. False negativity rate can be between 0-29% in patients who underwent SLNB, so the most important situation in SLNB is false negativity rates. The aim of our study is to discuss the success of noninvasive imaging methods that can be used instead of SLNB in the evaluation of the axilla. The data of patients who underwent breast cancer surgery between January 2019 and June 2021 in Muğla Sıtkı Koçman University Training and Research Hospital General Surgery Department were prospectively analyzed. Evaluation results of axilla with mammography, USG and MRI were compared with intraoperative SLNB and postoperative pathology results. During this study, patients' age, side, breast localization, multifocality and multicentricity, BIRADS classification of lesions (ACR), tumor size, histological type, grade, ER, PR, HER2 and Ki67 mitosis index, biological type, radiological status of axillary lymph nodes, lymph node cortex thickness and ADC values of lymph node and tumor on MRI, T and N staging (AJCC-8), SLNB and ALND results, lymphovascular and perineural invasion status were evaluated. 101 patients (Three patients were bilateral, a total of 104 breasts were evaulated) were included in the study. In our study, the mean ADC values of the metastatic lymph nodes measured were 0.820 x 10-3 mm2/s, and 0.850 x 10-3 mm2/s as benign lymph nodes. When the cut-off was assigned as 0.820 x 10-3mm2/s for the mean ADC value of the lymph node, the sensitivity was found to be 62% and the specificity as 50%.If the cut-off value for the tumor ADC value is determined as 0.935, the sensitivity is 75%, the specificity is 73%, the AUC value is 0.784 (p= 0.017), and if the cut-off value for the tumor ADC value / lymph node ADC value ratio is determined as 1.118, the sensitivity is 75%. , specificity 73%, AUC value of 0.736 (p=0.047).In our study, cortex thickness has higher sensitivity and specificity in detecting lymph node metastasis. When we determine the cut-off value on USG and 4.75 mm for the lymph node cortex thickness on USG, the sensitivity was 82%, the specificity was 60%, and the AUC value was 0.855 (p=0.015),When the cutoff value for cortex thickness was determined as 5.45 in MRI, the sensitivity was 90%, the specificity was 80%, and the AUC value was 0.827 (p=0.025).It is more powerful to utilize tumor ADC value, tumor ADC value / lymph node mean ADC value ratio and lymph node ADC value together in detecting axillary lymph node metastasis. Cortex thickness is more successful in detecting lymph node metastasis than ADC value. The sensitivity and specificity of MRI is higher than other imaging methods in detecting metastatic lymph node. Ultimately the studies are promising, currently there is no imaging method that can replace SLNB in detecting axillary metastases.