Clinical versus histopathological staging of axillary lymph node, in breast cancer patients

Abstract

Objective: To evaluate the validity of clinical examination of the axilla for detection or exclusion of presence of lymph nodes and performing clinical staging, in patients with breast carcinoma, in comparison with histopathological evaluation and staging Patients and methods: A case series study included ninety patients with breast carcinoma, done at Aljamhori Teaching Hospital in Mosul, during the period from January 2010 to June 2011. The diagnosis of breast cancer was confirmed by FNA and or excisional biopsy. The size of the tumors was measured and (T) stage was performed. The clinical evaluation of the axilla included: the presence or absence of axillary lymph nodes, the size, number, level and fixation of lymph nodes were assessed when positive; the clinical (cN) staging was recorded. All the patients underwent modified radical mastectomy with axillary clearance. The breast and axillae specimens were subjected to histopathological evaluation which included: the presence or absence of axillary lymph nodes, the size, number, level and fixation of lymph nodes were assessed when positive, the histopathological (hN) staging was recorded, which is regarded as the gold standard. The state of axillary lymph node (N), the size of the tumor (T) in relation of clinical to histopathological stages were evaluated and compared by using validity indicators, which includes the sensitivity, specificity, positive and negative predictive values and accuracy. P value was estimated using 2-way Contingency Table Analysis, with 95% Conf. Interval. Results: The study included 90 patients with breast carcinoma, the clinical evaluation revealed 20 patients (22%) with T1, 45 (50%) T2, 18 (20%) T3 and 7 (8%) T4. Sixty one (67.7%) patients had negative axillary lymph node (N0) on physical examination, those with positive lymph nodes were 19 (21%) patient with (N1), 7 (7.7%) patients with (N2) and 3 (3.3%) patients with (N3), while the histopathological evaluation showed that 35 (39%) patients had (N0), those with positive lymph nodes were 30 (33.3%) patient with (N1), 20 (22.2%) patients with (N2) and 5 (5.5%) patients with (N3). The sensitivity, specificity and accuracy of axillary lymph node examination were 40%, 70% and 57% respectively, the P value was 0.064. Conclusion: Clinical staging of axillary lymph node is neither sensitive nor specific, with low accuracy rate and it shouldn't be relied on for final staging in patient with breast malignancy.