Accuracy of Predicting Axillary Lymph Node Positivity by Physical Examination, Mammography, Ultrasonography, and Magnetic Resonance Imaging
- 7 January 2012
- journal article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 19 (6), 1825-1830
- https://doi.org/10.1245/s10434-011-2200-7
Abstract
Axillary lymph node status continues to be among the most important prognostic variables regarding breast cancer survival. We were interested in our ability to accurately predict axillary nodal involvement by using physical examination and standard breast imaging studies in combination. A retrospective review was performed of 244 consecutive patients diagnosed with invasive breast carcinoma between May 2008 and December 2010 who underwent physical examination of the axilla, digital mammography, axillary ultrasonography, and contrast-enhanced breast magnetic resonance imaging and who had subsequent histopathologic evaluation of one or more axillary lymph nodes. A total of 62 (25%) of 244 women were found to have positive axillary lymph nodes on final histopathologic examination, 42% of whom were able to be identified preoperatively. The sensitivity for predicting axillary metastasis if any one or more examination modalities were suspicious was 56.5%. The specificity for predicting axillary metastasis if any three or more modalities were suspicious was 100%. Of the patients who had all four modalities negative, 14% were ultimately found to have histologically positive nodes at the time of surgery. Physical examination and multimodal imaging in combination are useful for preoperative axillary staging and treatment planning. However, they remain inadequate definitive predictors of axillary lymph node involvement.Keywords
This publication has 21 references indexed in Scilit:
- Long-Term Morbidity of Sentinel Node Biopsy Versus Complete Axillary Dissection for Unilateral Breast CancerAnnals of Surgical Oncology, 2008
- Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trialThe Lancet Oncology, 2007
- Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsyThe American Journal of Surgery, 2007
- Morbidity After Sentinel Lymph Node Biopsy in Primary Breast Cancer: Results From a Randomized Controlled TrialJournal of Clinical Oncology, 2005
- Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy?Journal of the American College of Surgeons, 2005
- Sonographic Evaluation of Isolated Abnormal Axillary Lymph Nodes Identified on MammogramsJournal of Ultrasound in Medicine, 2004
- A Randomized Comparison of Sentinel-Node Biopsy with Routine Axillary Dissection in Breast CancerNew England Journal of Medicine, 2003
- Sentinel Lymph Node Biopsy for Breast Cancer: A Suitable Alternative to Routine Axillary Dissection in Multi-Institutional Practice When Optimal Technique Is UsedJournal of Clinical Oncology, 2000
- Sentinel lymphadenectomy in breast cancer.Journal of Clinical Oncology, 1997
- Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients.Journal of Ultrasound in Medicine, 1989