title: Retrospective preoperative assessment of the axillary lymph nodes in patients with breast cancer and literature review.
abstract: OBJECTIVE
  To evaluate the accuracy of axillary ultrasound, compared with published literature, identify women at low risk for lymph node (LN) involvement, and to determine which clinical, pathological, and imaging findings best predict LN involvement.
  
  
  METHODS
  From June 2010 to April 2012, 288 women with breast lesions that were suspicious of malignancy (category 4) or malignant (category 5) underwent axillary ultrasound examination. A 3 mm LN cortical thickness was used as the threshold to prompt fine-needle aspiration biopsy (FNAB) of the LN. Data were gathered regarding size, site, and grade of the index breast lesion and cortical thickness of the LN.
  
  
  RESULTS
  Using a cut-off point of <3 mm versus ≥3 mm, abnormal cortical thickness had a sensitivity and specificity of 56.3% and 86.7%, respectively. Breast cancer size was significantly associated with the odds of LN metastasis (p<0.001). There were 69 patients with breast cancers of ≤10 mm and 18% had positive axillary LNs. A much higher rate of malignancy was observed in breast cancers located in multiple sites and in a central location.
  
  
  CONCLUSIONS
  The likelihood of axillary LN metastasis increases with cortical thickness ≥3 mm and this concurs with the literature. A low-risk group of women was identified with screen-detected, low-grade small cancers with LNs with a cortical thickness of <3 mm. Additional features other than cortical thickness >3 mm (such as shape [rounding], echogenicity [markedly hypo-echoic cortex], and morphology [hilar compressional displacement, loss of echogenic outer capsule and angular margins]) should be used to indicate FNAB in patients with a palpable lump, multiple or central cancers, and cancers >20 mm.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Electronic address: bann.saffar@health.wa.gov.au.
authors.forename: B
authors.initials: B
authors.lastname: Saffar
authors.affiliation: Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Bennett
authors.affiliation: Anatomical Pathology, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Metcalf
authors.affiliation: Royal Perth Hospital and School of Medicine and Pharmacology, University of Western Australia, GPO Box X2213, Perth, WA 6847, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Burrows
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging*; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography