Preoperative ultrasound assessment of axillary lymph nodes in breast cancer: histopathological correlation in 100 cases
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KeywordsBreast Cancer Sentinel Lymph Node Sentinel Lymph Node Biopsy Axillary Lymph Node Fine Needle Aspiration
With the widespread adoption of sentinel lymph node biopsy, it is important to identify involved nodes preoperatively so that surgery can be planned appropriately.
One hundred consecutive cases of breast cancer were selected where the patient had axillary sampling or clearance. Ultrasound appearances of ipsilateral lymph nodes were scored U1 to U5 according to length/width ratio, cortical depth, size, and absence of fatty hilum. Fine needle aspiration cytology was performed if the nodes scored U3 to U5. Ultrasound and cytology findings were correlated with the resection specimens.
Of the 100 cases, 44 had positive lymph nodes at surgery. Fourteen of these had a preoperative C5 result. All 14 cases coded U4 or U5 had positive nodes, although 6 of these had cytology of C1 to C4. U3 with C3 to C5 occurred in seven cases, which were all positive. U3 with C1 to C2 occurred in 22 cases, of which 8 were positive. Fifty-seven cases were graded U1 or U2, of which 16 were positive. C1 occurred in six cases, of which four were positive. All 21 cases with C3 to C5 and/or U4 to U5 were positive. C2 falsely reassured in 7 of 19 cases where the nodes were subsequently shown to be involved. Sensitivity and specificity of a U3 to U5 result for positive nodes were 63% and 73%, respectively.
About one-third of positive patients avoided a second operation. Ways of improving the results are considered, including repeating all C1 cases, repeating C2 cases especially if U4 or U5, and fine needle aspiration even when nodes appear normal or benign.
This article is published under license to BioMed Central Ltd.