Ultrasonic features of automated breast volume scanner (ABVS) and handheld ultrasound (HHUS) combined with molecular biomarkers in predicting axillary lymph node metastasis of clinical T1-T2 breast cancer

Background: In the post-American College of Surgeons Oncology Group Z0011 trial era, clinicians are
attempting to preoperatively evaluate axillary lymph node (ALN) status using ultrasound. However, the value
of preoperative ultrasound examination remains uncertain. The study aimed to investigate the ultrasonic
features of automated breast volume scanner (ABVS) and handheld ultrasound (HHUS), in combination
with molecular biomarkers, to predict the risk of ALN metastasis (ALNM) in clinical T1-T2 breast cancer.
Methods: A retrospective case-control analysis was conducted on 168 patients with clinical T1-T2 breast
cancer at Peking University First Hospital between January 2013 and August 2021. Preoperative ABVS and
HHUS examinations were performed. According to the pathology results of the ALN, patients were divided
into metastatic and nonmetastatic groups. Logistic regression analyses were used to analyze the ultrasonic
characteristics of ABVS and HHUS on clinical T1-T2 breast cancer, and molecular biomarkers were
incorporated to predict the risk of ALNM.
Results: Of the 168 patients, 88 (52.4%) had ipsilateral ALNM while 80 (47.6%) had no ipsilateral
ALNM. The univariate analysis showed that shorter tumor-skin distance (P=0.011), the Adler blood flow
grade of II-III (P=0.014), and larger tumor size on ABVS (P<0.001) were associated with ALNM. The
multivariate logistic analysis showed that these three risk factors, including the tumor-skin distance [odds
ratio (OR) =0.279; P=0.024], the Adler blood flow grade (OR =2.164; P=0.046), and the tumor size on ABVS
(OR =1.033; P=0.002), were independent predictive parameters.
Conclusions: The tumor-skin distance, tumor size on ABVS, and Adler blood flow grade have diagnostic
value for ALNM in clinical T1-T2 breast