Axilla View of Mammography in Preoperative Axillary Lymph Node Evaluation of Breast Cancer Patients: A Pilot Study

Micro Abstract Evaluation of the axilla on conventional mammographic MLO view is limited. A novel mammographic position named axilla view was explored for axillary lymph node evaluation in breast cancer. Based on data from a total of 75 operable breast cancer patients, we observed a larger and clearer axillary region and markedly increased lymph nodes on axilla view. Purpose This study aimed to explore a novel position of mammography named axilla view in axillary lymph node (ALN) evaluation in breast cancer. Patients and Methods Patients were prospectively enrolled and scheduled for mammography before surgery. Investigated imaging patterns included mediolateral oblique (2D-MLO) and axilla view (2D-axilla) of mammography, and axilla view of digital breast tomosynthesis (3D-axilla). The correlation of ALN numbers between imaging and pathology was analyzed. Diagnostic performance was analyzed via AUC. Results 75 patients were included. A larger and clearer axillary region was displayed in axilla view. The total number of ALNs detected under 2D/3D-axilla view was significantly higher than that under 2D-MLO view (4.6 vs 2.5, P < 0.001; 5.6 vs 4.6, P = 0.034). Correlations between number of positive ALNs detected under 2D/3D-axilla view and pathologically confirmed metastatic ALNs were stronger than 2D-MLO view (Pearson correlation coefficients: 0.7084,0.7044 and 0.4744). The proportion of cases with ≥5 positive ALNs detected under 3D-axilla view was significantly higher than that under 2D-MLO (38.2% vs 14.7%, P = 0.028). The overweight and obese group showed a higher AUC value than the underweight and lean group in ALN evaluation, although not significantly (2D-MLO: 0.7643 vs 0.6458, P = 0.2656; 2D-axilla: 0.8083 vs 0.6586, P = 0.1522; 3D-axilla: 0.8045 vs 0.6615, P = 0.1874). This difference was more pronounced in axilla view. Conclusion Axilla view exhibited advantages over conventional MLO view in the extent of axilla displayed by mammography in breast cancer. Further studies with larger sample sizes are needed.