2. Department of Radiology, Parapet Breast Centre, Frimley Health Foundation Trust, King Edwards VII Hospital, Windsor, SL4 3DP, United Kingdom.
3. Department of Histopathology, Wexham and Heatherwood Hospital, Frimley Health Foundation Trust, slough, SL2 4DP, United Kingdom.
Background: Pre-operative diagnosis of axillary node status is important in the management of patients with breast cancer. Ultrasound scanning (US) is an essential part of triple assessment of these patients with biopsy by either fine needle aspiration cytology (FNAC) and/or core biopsy (CB) of suspicious lymph nodes. The aim of this study is to establish the accuracy of preoperative US scan with US guided needle biopsy (USB) of suspicious nodes in the diagnosis of metastatic disease. Compliance with the current recommendations of the Royal College of Radiologists (RCR) was audited.
Material and methods: A retrospective analysis of all patients diagnosed with invasive breast cancer from April 2015 till March 2016 who underwent preoperative US axillary assessment followed by axillary surgery. Preoperative ultrasounds and US guided FNAC or CB of axillary lymph nodes were correlated with final histology of sentinel lymph node biopsy (SLN) or axillary lymph node clearance (ALND). Patients with micro-metastasis were excluded from this analysis.
Findings or results: 292 patients were identified (163 symptomatic invasive breast cancers and 129 screen detected). Following axillary surgery 95 /292 (32.5%) patients had nodal metastatic involvement on final histology. 68/163 (41.7%) of the symptomatic group had proven metastatic disease on final histology whereas only 27/129 (20.9%) of the screen detected group had metastatic disease. The sensitivity of US alone diagnosis in the symptomatic group was 73.5% and US guided sampling was 76% whereas in the screening group the sensitivity of ultrasound was 44.4% and ultrasound biopsy83% respectively.
Conclusions: Our results better the Royal College of Radiology guidelines (target of 50% or above) for both US assessment and US guided biopsy for symptomatic group. The screening group results were lower than the symptomatic group which probably is a reflection of a lower metastatic burden.
Keywords: Breast cancer, axillary lymph nodes, ultrasound scan, metastases, needle biopsy