Is Axillary Scanning Necessary with Negative Finding on Both Mammography and Subsequent Breast Ultrasound?

Abstract

The purpose of our studywas to assess cancer detection rate and positive predictive value (PPV) for incidentally detected abnormal axillary lymph nodes (LNs) with negative findings on both mammography and subsequent breast ultrasound (US). We retrospectively reviewed 13,573 records for screened patients from January 2012 to March 2015 with negative mammography and subsequent breast US results. We reviewed medical charts for US-guided axillary LN biopsy and cytopathological results, records of follow-up US for at least 12 months, family history, and previous operation and past cancer history. We calculated cancer detection rate, PPV for biopsy, axillary biopsy performed, and cancer rate for patients by family history, previous operation, and past cancer history. We included 7,039 patients (mean age, 52 years) with positive results from US-guided LN biopsy (n=2), or follow-up US (n=7,037). In two patients with positive LNs, none of them from breast malignancy, but endometrial cancer or follicular lymphoma. The calculated cancer detection rate was 0.3 per 1,000 axillary US, PPV for biopsy was14.3%, and axillary biopsy performed rate was 0.2%. Cancer rates were 0% for patients with a family history or previous operation history, 0.1% with past cancer history, and 0.2% for no family, operation or cancer history. Our results indicated that cancer detection rate and PPV for US were too low to recommend routine axillary scanning including screening breast US in patients with negativefindings on both mammography and subsequent breast US, especially without past history of any cancers.