The Accuracy of Axillary Ultrasonography for Patients with T1-2 Breast Cancers.

Han,  Boo Kyung; Shin,  Jung Hee; Ko,  Eun Young; Lim,  Hyo K; Cho,  Eun Yoon; Choi,  Yoon La; Nam,  Seok Jin; Yang,  Jung Hyun

Journal of Korean Society of Ultrasound in Medicine 2009;28(3): 155-161.

Boo Kyung Han, Jung Hee Shin, Eun Young Ko, Hyo K Lim, Eun Yoon Cho, Yoon La Choi, Seok Jin Nam, Jung Hyun Yang

¹Department of Radiology, Sungkyunkwan University, School of Medicine, Samsung Medical Center, Korea. bkhan@skku.edu
²Department of Pathology, Sungkyunkwan University, School of Medicine, Samsung Medical Center, Korea.
³Department of Surgery, Sungkyunkwan University, School of Medicine, Samsung Medical Center, Korea.

Published online: September 1, 2009.

ABSTRACT

PURPOSE: We wanted to investigate the accuracy of axillary ultrasonography for detecting axillary nodal metastasis in patients with T1-2 breast cancer and we also wanted to determine the factors affecting the sensitivity. MATERIALS AND METHODS: Two radiologists performed axillary ultrasonography in 119 consecutive patients with T1-2 breast cancer and clinically uninvolved axillae. We analyzed the accuracy of ultrasonography for detecting axillary nodal metastasis with the histologic results being used as a reference standard. We evaluated the number of involved lymph nodes, T staging and the histologic grade of the tumors. RESULTS: Axillary nodes were involved in 39% of total patients (46/119); 30% of the patients with T1 cancer and 55% of the patients with T2 cancer. The sensitivity, specificity, positive predictive value and negative predictive value were for 52%, 92%, 80% and 75%, respectively. The sensitivity was significantly lower for the cases with one to two lymph nodes metastasis and T1 cancer than in those cases with 3 or more lymph nodes metastasis and T2 cancer (35% and 75% in the cases with 1-2 cancer and the cases with > 3 lymph nodes metastasis, respectively, p = 0.009; 38% and 68% in the cases with T1 and the cases with T2 cancer, respectively, p = 0.045). CONCLUSIONS: The ultrasonographic sensitivity for detecting axillary lymph node metastasis is low, especially in the cases with one to two lymph nodes metastasis and the cases with T1 cancer. Detailed analysis and adoption of cytologic examination of the axillary lymph nodes are necessary to improue the accuracy of ultrasonography.

Keywords: Breast Cancer; Axilla; Ultrasonography; Lymph Nodes