1.1. Introduction: Axillary lymph node(ALN) status is an important prognostic factor for breast cancer. The high accuracy of axillary ultrasound(AUS) has led to several ongoing trials where sentinel lymph node biopsy(SLNB) omission is explored for negative AUS in early breast cancer. We aimed to correlate pre-operative ALN status with final histology. Specifically, we sought to identify factors associated with a false negative AUS.
Materials & Methods:An 11-year retrospective review of breast cancer patients who underwent surgery between 1st January 2006 and 31st December 2016 at a tertiary Breast Unit, was performed. Ultrasound ALN characteristics, preoperative biopsy findings and final postoperative histology were evaluated. Women with clinically non-palpable axillary nodes were included.1.3. Results: 1665 breast cancer patients were evaluated. 368 patients had an abnormal preoperative AUS. Axillary metastasis was 18-fold higher in patients with an abnormal AUS (P <0.001, 17.927, 95% CI: 13.493 to 23.820). However, 15.3%(198 of 1297) of those with a normal AUS had axillary metastases. The sensitivity, specificity, positive predictive value and negative predictive value were 58.7%, 92.7%, 76.4% and 84.7% respectively. Loss of fatty hilum and tumour size were independent predictors of ALN metastases.The low sensitivity of the ALN on preoperative ultrasound may not be sufficiently accurate to determine the true presence of ALN metastasis. 1518 patients underwent an SLNB. 22.1% (336 of 1518 patients) had ALN involvement.
Conclusion:A normal preoperative axillary ultrasound is insufficient to negate the need for SLNB. SLNB is still necessary for accurate staging and treatment of breast cancer.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.