Reliability of axillary staging by ultrasound in breast cancer patients

Purpose To determine the role of ultrasound (US) to detect extensive axillary disease in patients with breast cancer.

Methods Between 01/2016 and 01/2020 593 patients were selected, who either received a biopsy of the axilla immediately after axillary ultrasound (AUS) (in an adjuvant or neoadjuvant setting) or who were diagnosed with breast cancer in an adjuvant setting and underwent axillary ultrasound and later on surgery including assessment of their nodal status by sentinel node biopsy or axillary dissection.During axillary ultrasound, lymph nodes were defined as suspicious whenever they showed a cortical thickness of > 3,0 mm.

Results Out of the 593 patients, pathological lymph nodes were correctly detected using ultrasound in 140 (N+). In 353, the axilla was correctly classified as N0. False positive US diagnoses of lymph nodes were seen in 22 cases (N0). Axillary metastases were missed by US in 78 patients (N+). However, in these 78 patients, transcapsular growth of the lymph node metastasis was described in only 27 and extensive axillary spread (> 2 nodes/axilla) in only 14.

Based on this data, the resulting negative predictive value (95 % CI) for transcapsular growth is 92,9 % (89,8 - 95,3), for extensive axillary spread 96,2 % (93,7 - 97,9)

Conclusion Cortical thickness measured by AUS is useful for detecting lymph node metastasis in patients with breast cancer. It is, however, particularly efficient in the detection of metastasis with transcapsular growth or extensive axillary disease.

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Publication History

Article published online:
01 June 2021