title: The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer.
abstract: OBJECTIVE
  Recent reports indicate a lack of survival benefit for axillary lymph node dissection (ALND) versus sentinel lymph node biopsy in early breast cancer. To study this issue further, we assessed the accuracy and effectiveness of ultrasound examination in detecting axillary nodal involvement in breast cancer patients with the aim of refining our current clinical pathways.
  
  
  METHODS
  Ultrasound data were collected from breast cancer cases over 3 years. Images were reviewed by experienced radiologists and the following characteristics were assessed: size, morphology, hyperechoic hilum, and cortical thickness of the ipsilateral axillary nodes. The findings were correlated with histologic outcomes after ALND.
  
  
  RESULTS
  Two hundred twenty-four cases were included in the analysis, 113 (50.4%) of which had evidence of metastatic nodal involvement at final histology. Of these 113 cases, ultrasound findings for 59 (52.2%) were positive. The overall positive predictive value of ultrasound for detecting metastatic nodal involvement measured 0.81. The negative predictive value was 0.60. The sensitivity was 53.7%; specificity, 85.1%; and accuracy, 67.9%. The ultrasound morphologic lymph node features with the greatest correlation with malignancy were the absence of a hyperechoic hilum (p = 0.003) and increased cortical thickness (p = 0.03). Patients with a metastatic nodal burden density of at least 20% were more likely to have abnormal findings on axillary ultrasound examination (p = 0.009).
  
  
  CONCLUSIONS
  Axillary ultrasound has a low negative predictive value and negative ultrasound results do not exclude axillary node metastases with sufficient sensitivity to justify its routine clinical use. Clinical pathways need to consider an evidence-based approach, focusing on the criteria by which we select breast cancer patients for ALND.
authors: Department of Medical Oncology, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors: Belinda
authors: B
authors: Lee
authors: Adrian K
authors: AK
authors: Lim
authors: Jonathan
authors: J
authors: Krell
authors: Keshthra
authors: K
authors: Satchithananda
authors: R Charles
authors: RC
authors: Coombes
authors: Jacqueline S
authors: JS
authors: Lewis
authors: Justin
authors: J
authors: Stebbing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000556:secondary*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult