Identifying Axillary Metastases in Patients with T3 Invasive Lobular Carcinoma

Strategic Insights -

A recent study published in the Southern Medical Journal has shed light on the challenges of diagnosing axillary lymph node (ALN) metastases in patients with invasive lobular carcinoma (ILC). Researchers from the H. Lee Moffitt Cancer Center conducted a retrospective review of patients with pT3 ILC between 2014 and 2023, evaluating the use of axillary ultrasound (AUS) and magnetic resonance imaging (MRI) in predicting ALN metastases.

Key Takeaways:

  • The study found that surgeons should have a high index of suspicion for axillary disease, despite a negative preoperative evaluation, as ALN metastases are difficult to diagnose in ILC.
  • The use of axillary ultrasound (AUS) and magnetic resonance imaging (MRI) was evaluated as a tool for predicting ALN metastases in patients with ILC tumors larger than 5 cm.
  • The study demonstrated that AUS and MRI had sensitivities of 67.9% and 56.3%, respectively, and specificities of 96.7% and 84.6%, respectively, for predicting ALN metastases.
  • The positive predictive value (PPV) for AUS was 87.5%, and for MRI, it was 62.5%.
  • The negative predictive value (NPV) for AUS was 90.9%, and for MRI, it was 72.7%.
  • The study's findings suggest that a combination of clinical evaluation, imaging, and pathological assessment may improve the detection of ALN metastases in patients with ILC.
  • The study involved a retrospective review of 235 patients with pT3 ILC between 2014 and 2023.
  • The study's participants had a median age of 55.5 years, with 74.7% identified as female.
  • The study found that 126 patients (53.7%) had ALN metastases, with 115 patients (49.1%) having N1 disease and 11 patients (4.7%) having N2 disease.
  • The study demonstrated a statistically significant correlation between tumor size and the presence of ALN metastases.

Statistics:

  • Sensitivity of axillary ultrasound (AUS) for predicting ALN metastases: 67.9%
  • Sensitivity of magnetic resonance imaging (MRI) for predicting ALN metastases: 56.3%
  • Specificity of AUS for predicting ALN metastases: 96.7%
  • Specificity of MRI for predicting ALN metastases: 84.6%
  • Positive predictive value (PPV) of AUS for predicting ALN metastases: 87.5%
  • Positive predictive value (PPV) of MRI for predicting ALN metastases: 62.5%
  • Negative predictive value (NPV) of AUS for predicting ALN metastases: 90.9%
  • Negative predictive value (NPV) of MRI for predicting ALN metastases: 72.7%

Sources:

  • Identifying Axillary Metastases in Patients with T3 Invasive Lobular Carcinoma. Southern Medical Journal, 2025;118(10):687-691.
  • Southern Medical Journal. Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA. (www.lww.com; journals.lww.com/smajournalonline/pages/default.aspx)
  • H. Lee Moffitt Cancer Center. Paige Aiello, Dept. of Breast Oncology, Tampa, Florida.