Role of Axillary Ultrasound in Defining Surgical Management of Breast Cancer Patients with Nodal Disease.

Abstract

Background:With the introduction of Sentinel Lymph Node Biopsy, breast cancer patients with nodal disease have to undergo second surgical axillary procedure. The aim of our study was to correlate the accuracy of ultrasound in redefining surgery in breast cancer patients.Methods:The records of all breast cancer patients who underwent Axillary Lymph Node Dissection (ALND) from January 2008 to December 2008 were reviewed. Of these, patients who had pre operative axillary ultrasound and/or fine needle aspiration cytology were included. All ultrasound were performed by the radiologist with special interest in breast imaging at our breast centre. Comparison of the ultrasound and FNA findings with ALND findings was performed.Results:Seventy Five patients had axillary ultrasound during this period. Twenty five patients (32.3%) had abnormal ultrasound findings. Of these, 22 patients had positive surgical staging and three patients had negative surgical staging. Ten of the abnormal axilla had FNAC done. Of these, seven patients had metastatic cells and all of these patients have finally proven to have positive axillary lymph nodes. Of the fifty patients (67.7%) with normal axilla, 34 patients had negative surgical staging and 16 had positive staging The sensitivity of ultrasound axilla was 57.89%, and specificity was 96%. The positive predictive value was 88% and the negative predictive value was 78.57%Discussion:Ultrasound examination of axilla is a safe and fast method of assessing the lymph nodal status in the preoperative staging of axilla. The results of our study are mostly in agreement with previous published studies. This will reduce the number of patients having to undergo a second axillary procedure, hence saving resources both financially and operating time. It will reduce the number of hospital admissions for the patient; improve cost effectiveness and the patient pathway. We therefore recommend routine axillary ultrasound with FNAC of suspicious/pathological nodes to avoid sentinel node procedure i.e., proceed directly to axillary clearance. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1033.