Ultraschall Med 2008; 29 - OP_2_4
DOI: 10.1055/s-2008-1079803

Axillary high resolution ultrasound in preoperative assessment of patients with breast carcinoma

A Chrysostomou 1, N Stavrou 1, S Panagiotou 2, S Avgousti 2
  • 1Breast Care Center & Oncology Diagnostics, Limassol, Cyprus
  • 2Diagnostic Center Of Histopathology – Cytology, Limassol, Cyprus

Aim: The importance of axillary sonographic evaluation in patients with BIRADS 6 lesions, using a retrospective analysis of ultrasound morphologic criteria for lymph node metastases correlated to the postoperative histologic results.

Methods: High resolution bilaterally axillary ultrasound was performed for preoperative assessment in 105 patients with FNA or core biopsy confirmed breast carcinoma. The sonographic positive lymph nodes were considered using 3 morphologic criteria: mass-like appearance, focal cortical thickening and diffuse cortical thickening, greater than 3mm with hilum preservation. The results were compared with axillary dissection or sentinel lymph node histological status.

Results: The overall sensitivity and specificity were 70.31% and 92.30%, with a positive predictive value 90.00% and a negative predictive value 75.94%

31 patients had ultrasound positive lymph nodes, 26 (83.87%) of them being true positives. From those:

  • 11 had mass like appearance with correspondent histology: 1 to 3 positive lymph nodes -5 cases, 11 to15 positive lymph nodes –4 cases and 5 positive lymph nodes 1 case, 1 was false positive (primary axillary tumor)

  • 5 had focal cortical thickening with final histology: 1 to 3 positive lymph nodes –4 cases and 5 positive lymph nodes -1 case

  • 10 had diffuse cortical thickening with: 1 to 3 positive lymph nodes -5 cases, 5 positive lymph nodes -1 case and 11 to 15 positive lymph nodes –4 cases, 4 was false positive

The total of true positive cases was 45, so the ultrasound exam missed 19. While analyzing the histology of sonographic false negative cases, we observed that in 5 cases there were micrometastases in one lymph node, in 11 there were 1 to 3 positive lymph nodes and in 3 there where 4 positive lymph nodes.

Conclusion: High resolution ultrasound can predict axillary lymphnode metastases in a significant percentage of patients with breast carcinoma and could orient the surgeon to the appropriate technique.