Supplementary Figure 1: Blinded review comparing adjuvant systemic therapy recommendations made by two medical oncologists versus actual systemic therapy given in patients with negative AUS
False Negative AUS Matched True Negative AUS
Actual Reviewer #1 Reviewer #2 Actual Reviewer #1 Reviewer #2
Legend:
Black: Chemotherapy and endocrine therapy Blue: Endocrine therapy
Yellow: Chemotherapy, herceptin and endocrine therapy Green: Chemotherapy
Gray: Observation
Purple: Chemotherapy and herceptin therapy Orange: Herceptin and endocrine therapy Red: Herceptin
Supplementary Table 1: Univariate analysis comparing negative predictive value of axillary ultrasound by patient and tumor characteristics
N Detection of micrometastatic or
macrometastatic disease Detection of macrometastatic disease only
NPV p-value NPV p-value
Overall 382 84% - 89%
Age
< 50 years 66 77% 0.15 85% 0.19
> 50 years 316 85% 90%
Histology
Ductal 310 83% 0.06 89% 0.17
Lobular 33 76% 85%
Other 39 95% 97%
Tumor size
T1 264 86% 0.04 90% 0.47
T2 118 77% 87%
Grade
I/II 265 83% 0.77 89% >0.99
III 116 85% 89%
ER
Positive 309 82% 0.22 89% 0.53
Negative 73 89% 92%
HER2
Positive 49 76% 0.15 84% 0.22
Negative 330 85% 90%
TNBC
Yes 56 89% 0.25 91% 0.82
No 323 82% 89%
NPV, negative predictive value; ER, estrogen receptor; TNBC, triple negative breast cancer
(estrogen receptor negative, progesterone receptor negative, and HER-2 negative)
Supplementary Table 2: Demographic and clinicopathologic characteristics of blinded review patients in Group 1 (False Negative AUS) and Group 2 (True Negative AUS)
Characteristics Group 1 Group 2 p-value
Age (years) 0.31
Median (range) 61 (33-88) 62 (35-83)
Tumor Histology 0.013
Invasive ductal 52(84) 59 (98)
Invasive lobular 8 (13) 0 (0)
Other 2 (3) 1 (2)
Tumor Size < 0.001
T1 34 (55) 59 (98)
T2 28 (45) 1 (2)
Tumor Grade 0.387
I 15(24) 21 (36)
II 29(47) 24 (41)
III 18(29) 14 (23)
ER status 0.200
Positive 54 (87) 47 (78)
Negative 8 (13) 13 (22)
Unknown 0 (0) 0 (0)
PR status 0.096
Positive 53 (86) 44 (73)
Negative 9 (15) 16 (27)
Unknown 0 (0) 0 (0)
HER2 status 0.290
Positive 11 (18) 6 (10)
Negative 51 (82) 53 (88)
Unknown 0 (0) 1 (2)
TNBC 0.168
No 56 (90) 49 (82)
Yes 6 (10) 11 (18)
Neoadjuvant therapy 0.384
Chemotherapy 6 (10) 2 (3)
Endocrine 1 (2) 1 (2)
None 54 (87) 57 (95)
Median F/U, months (range) 36 (1-61) 36 (2-60) 0.805
Recurrence
Breast 1 (2) 1 (2) 0.981
Axilla 0 (0) 1(2) 0.307
Distant 3 (5) 3(5) 0.967
