Abstract P1-01-08: Diagnostic accuracy of pre-operative ultrasonographic evaluation of axillary lymph nodes in breast cancer patients: Is there a place for axillary ultrasonography in future nomograms?

Abstract

Abstract Background During the years there has been a significant interest in the development of clinical prediction tools to estimate the risk of having positive lymph nodes in the axilla, and thereby making it possible to plan specific therapies. A non-invasive and widely available method is axillary ultrasonography. Aim The purpose of this study was to evaluate the diagnostic accuracy of axillary ultrasonography. Patients and methods Between January 2007 and July 2011, pre-operative axillary ultrasonography was performed in 1124 consecutive primary breast cancer patients who underwent surgery with sentinel node biopsy (SNB) and/or complete axillary lymph node dissection (ALND). Suspected lymph nodes (cortex thickness > 2.3 mm) were further analysed by cytology or histology. In case of a negative axillary ultrasonography, standard SNB was performed during operation. In case of suspected lymph nodes with axillary ultrasonography, confirmed by biopsy, routine complete ALND was performed. Results Of the 1124 patients, 922 (82%) had unsuspected lymph nodes and 202 (18%) had suspicious lymph nodes during axillary ultrasonography. The sensitivity and specificity of axillary ultrasonography was 46.6% and 93.0% respectively in case of a macrometastases. In all cases of suspected malignancy, axillary core biopsy was performed. The sensitivity and specificity of axillary ultrasonography in combination with core biopsy was 40.5% and 97.2% respectively. With increasing number of axillary nodes the sensitivity increases: 53.9% in case of 2 macrometastases and 83.3% in case of 3 macrometastases. Conclusion Ultrasonography and core biopsy are effective in predicting the presence of axillary metastases in breast cancer patients. Especially the high specificity might be of additional value for future nomograms in the surgical treatment of breast cancer patients. In addition, the sensitivity is of greater value in case of gross nodal disease. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-08.