Evaluation of the diagnostic accuracy of preoperative ultrasound for axillary lymph nodes in breast cancer patients

Abstract

Background Breast cancer is the most prevalent cancer and the second leading cause of death among women is breast cancer. The likelihood of survival rises with early breast cancer diagnosis, which lowers death rates. For the treatment of breast cancer, axillary lymph nodes (ALNs) must be correctly staged and managed. The main goals of ALNs staging are to gather prognostic data and information that might influence management decisions. Objective To evaluate the accuracy of the preoperative ultrasound in detection of malignant ALNs in breast cancer patients. Methods The records of breast cancer patients at the breast surgery unit of Kasr Alainy Hospital, between 2017 and 2020, were reviewed. Patients with an axillary ultrasound report who underwent a sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) were enrolled in the present study. Demographic and clinicopathologic characteristics including age, family history, body mass index (BMI), primary tumor size, histological and biological grade, Lymphovascular invasion (LVI), extracapsular invasion (ECE), were evaluated. Results Out of the 348 Breast Cancer patients who were managed in our department, the age range was 28–89 years (median age 52 years). The histopathology results of the tumor were 96% with invasive duct carcinoma (IDC) 2.3% invasive lobular carcinoma (ILC) and 1.7% were mixed ductal/lobular. Cortical thickness greater than 3 mm had a significant difference for positive nodal status, effacement of hilum had a sensitivity 56.2% in detecting positive lymph nodes (LNs), round LNs shape had a sensitivity of 82.3% in detecting true positive LNs. Pathological LNs by ultrasound had a sensitivity of 93% and specificity of 77% in detecting true positive LNS, BMI was not significant in ultrasound detection of pathological LNs. Conclusion The data shows that axillary ultrasound by its assessment has revealed to be useful in detection of malignant LNs with a sensitivity of 93.1% and specificity 77% in detecting true malignant LNs.