Diagnostic Accuracy of Axillary Ultrasonography Compared with Intra-operative Pathological Findings in Patients with Breast Cancer

Abstract

Objective: Breast cancer is the most common cancer and leading cause of mortality in women worldwide. Diagnosis of<br />axillary lymph node involvement, frequently by axillary ultrasonography (AUS), is an important step in patients with<br />primary breast cancer, while the gold standard pathological examination is only applicable during surgery. Thus,<br />we aimed to evaluate the predictive value of AUS in detection of lymph node involvement. Methods: A total of 56<br />patients with primary breast cancer, who were candidate of mastectomy were included in this study. A single radiologist<br />performed pre-operative axillary sonography for all the patients and reported the results in a checklist. The results<br />were then compared with intra-operative pathological results of lymph node dissection to evaluate the sensitivity,<br />specificity, positive and negative predictive values of AUS in detection of the disease. Result: The results showed that<br />pre-operative AUS had a sensitivity of 63.3%, specificity of 84.6%, positive predictive value of 82.6%, and negative<br />predictive value of 66.6%. Correlation between axillary lymph node characteristics revealed that the absence of fatty<br />hilum, cortical thickness, and loss of ovality of the lymph nodes were the most specific factors in detection of lymph<br />nodes' involvement. Conclusion: AUS has a low sensitivity and cannot determine the presence of micro-metastases<br />and suspicious lymph nodes accurately in early stages of the disease, and it seems that defining new parameters may<br />help for increasing the sensitivity and specificity of the axillary lymph node sonography. Apparently, pathological<br />examination remains the gold standard diagnostic method.