title: The impact of preoperative axillary ultrasonography in T1 breast tumours.
abstract: OBJECTIVE
  To (a) determine the diagnostic validity of axillary ultrasound (AUS) in pT1 tumours and whether fine-needle aspiration (FNA) improves its diagnostic performance, and (b) determine the negative predictive value (NPV) of AUS in a simulation environment (cutoff: two lymph nodes with macrometastases) in patients fulfilling American College of Surgeons Oncology Group (ACOSOG) Z0011 criteria.
  
  
  METHODS
  This retrospective multicentre cross-sectional study analysed diagnostic accuracy in 355 pT1 breast cancers. All patients underwent AUS; visible nodes underwent FNA regardless of their AUS appearance. Sentinel node biopsy and axillary lymph node dissection (ALND) were gold standards. Data were analysed considering micrometastases 'positive' and considering micrometastases 'N negative'. The simulation environment included all patients fulfilling ACOSOG Z0011 criteria.
  
  
  RESULTS
  Axillary involvement: 22.8 %; AUS sensitivity: 46.9 % (Nmic positive)/66.7 % (Nmic negative); AUS+FNA sensitivity: 52.6 % (pNmic positive)/72.0 % (pNmic negative). In the simulation environment, AUS had 75.0 % sensitivity, 88.9 % specificity and 99.2 % NPV.
  
  
  CONCLUSIONS
  AUS has moderate sensitivity in T1 tumours. As ALND is unnecessary in micrometastases, considering micrometastases 'N negative' increases the practical impact of AUS. In patients fulfilling ACOSOG Z0011 criteria, AUS alone can predict cases unlikely to benefit from ALND.
  
  
  CONCLUSIONS
  • AUS+FNA can predict axillary involvement, thus avoiding SNB. • Not all patients with axillary involvement need ALND. • Axillary tumour load determines axillary management. • AUS could classify patients according to axillary load.
authors.affiliation: Women's Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Institut Universitari Parc Taulí - UAB, 1 Parc del Taulí, Sabadell, Barcelona, Spain. jdelriego@tauli.cat.
authors.forename: Javier
authors.initials: J
authors.lastname: del Riego
authors.affiliation: Breast Imaging, Department of Radiology, Althaia Xarxa Assistencial Universitària de Manresa, 1-3 Dr. Joan Soler St., Manresa, Barcelona, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Diaz-Ruiz
authors.affiliation: Breast Imaging, Department of Radiology, Consorci Sanitari de Terrassa, s/n Torrebonica Av., Terrassa, Barcelona, Spain.
authors.forename: Milagros
authors.initials: M
authors.lastname: Teixidó
authors.affiliation: Breast Imaging, Department of Radiology, Consorci Hospitalari de Vic, Hospital General de Vic, 1 Francesc Pla "el vigata" St., Vic, Barcelona, Spain.
authors.forename: Judit
authors.initials: J
authors.lastname: Ribé
authors.affiliation: Women's Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Institut Universitari Parc Taulí - UAB, 1 Parc del Taulí, Sabadell, Barcelona, Spain.|Breast Imaging, Department of Radiology, Hospital General de Granollers, Hospital Universitari, Fundació Privada Hospital Asil de Granollers, s/n Francesc Ribas Av., Gronollers, Barcelona, Spain.
authors.forename: Mariona
authors.initials: M
authors.lastname: Vilagran
authors.affiliation: Breast Imaging, Department of Radiology, Hospital Universitari Mútua Terrassa, 5, Doctor Robert Pl., Terrassa, Barcelona, Spain.
authors.forename: Lydia
authors.initials: L
authors.lastname: Canales
authors.affiliation: Women's Imaging Service, Department of Radiology, UDIAT Centre Diagnòstic, Institut Universitari Parc Taulí - UAB, 1 Parc del Taulí, Sabadell, Barcelona, Spain.
authors.forename: Melcior
authors.initials: M
authors.lastname: Sentís
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D014463:Ultrasonography; D055815:Young Adult
keywords: Axillary surgery; Axillary ultrasound; Breast cancer; Percutaneous biopsy; Sentinel lymph node biopsy