Lona Jalini1, Dave Fok Nam Fung1, Kaushik Kumar Dasgupta1, Vijay Kurup1.
1) Department of General Surgery, Breast Unit, North Tees and Hartlepool University Hospital NHS Foundation Trust, Hardwick Road, UK.
Disclosure: The author has declared no conflicts of interest.
Received: 24.11.15 Accepted: 12.01.16
Axillary lymph node status is the most important breast cancer prognostic factor.Preoperative axillary ultrasound examination (PAUS) is used to triage patients for sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). We assessed the detection rate of lymph node metastases by PAUS in a screening unit and evaluated associations between clinicopathological factors and PAUS positivity.
Patients and Methods: This was a single-centre retrospective analysis of data extracted from a hospital breast cancer database and clinical records. Clinical, radiological, and pathological and prognostic indices were compared between PAUS-positive and PAUS-negative patients subsequently found to have lymph node metastases on histopathological analysis.
Results: Two hundred and two patients were eligible for analysis. 50.5% of lymph node-positive patients were correctly identified as PAUS positive. Patients with PAUS-positive lymph nodes had less favorable disease characteristics, namely clinically palpable lymph nodes, higher Nottingham prognostic (NPI) index, high lymph node burden according to the European Society of Medical Oncology (ESMO) group classification, and larger, grade 3 tumors with lymphovascular invasion and extranodal spread. Moreover, PAUS-positive patients had more macrometastases and lymph node involvement than PAUS-negative patients.
Conclusion: PAUS-positive patients and PAUS-negative (SLNB-positive) patients have different clinicopathological characteristics. The presence of LVI, extranodal spread, grade 3 histology, or large tumors with poor prognostic indices in PAUS-negative patients should be regarded with caution and perhaps prompt second-look ultrasound examination.
Keywords: Preoperative axillary ultrasound scan; sentinel lymph node biopsy; breast cancer
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