title: Role of ultrasonography to detect axillary node involvement in operable breast cancer.
abstract: Prompted by the concern about unnecessary axillary dissections, we prospectively studied the accuracy of clinical examination (CE) and conventional ultrasonography (USG, 7.5 MHz), to diagnose pre-operatively metastatic axillary lymph nodes in 200 operable breast cancer patients. USG had higher specificity (90% vs 77%, P = 0.025) and higher positive predictive value (ppv = 90% vs 76%, P = 0.02) than CE. Together, CE + USG had higher sensitivity (82% vs 58%, P = 0.00005) and higher negative predictive value (npv = 76% vs 58%, P = 0.008) than CE alone. In women < 45 years, CE + USG had higher sensitivity (91% vs 76%, P = 0.037) and npv (89% vs 67%, P = 0.018) than in older women. The sensitivity and npv of CE + USG to detect > 1 positive node were 97% (for both) in women < 45 years compared to 81% and 79% in older women. The high sensitivity of CE + USG (82% for the whole group) is probably due to the higher proportion of young women (median age = 45) in our population. It suggests that using CE + USG to avoid axillary dissection in some patients is feasible.
authors.affiliation: Department of Surgery, Tata Memorial Hospital, Bombay, India.
authors.forename: J S
authors.initials: JS
authors.lastname: Vaidya
authors.forename: J J
authors.initials: JJ
authors.lastname: Vyas
authors.forename: M H
authors.initials: MH
authors.lastname: Thakur
authors.forename: K C
authors.initials: KC
authors.lastname: Khandelwal
authors.forename: I
authors.initials: I
authors.lastname: Mittra
mesh_terms: D000328:Adult; D000367:Age Factors; D001365:Axilla / Q000000981:diagnostic imaging* / Q000601:surgery; D001835:Body Weight; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010173:Palpation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography