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| |  Preoperative Axillary Ultrasound Useful in Diagnosing Early Breast Cancer: Presented at SSO By Jill Stein ST. LOUIS, Mo -- March 5, 2010 -- Preoperative ultrasound of the axilla seems to be a good diagnostic modality in women with early-stage breast cancer, according to a study presented here today at the 2010 Society of Surgical Oncology Annual Cancer Symposium (SSO). Jonathan Cools-Lartigue, MD, McGill University Health Center, Montreal, Quebec, and colleagues studied the usefulness of preoperative axillary ultrasound in identifying women with lymph node-positive disease. “The concept of lymphatic drainage to 1 or more sentinel lymph nodes in breast cancer has been validated prospectively by multiple studies,” said Dr. Cools-Lartigue. “Accordingly, sentinel lymph node biopsy represents the standard of care in the operative management of breast cancer.” To date, no other modality demonstrating an accuracy exceeding 90% to 95% has been validated prospectively for the prediction of axillary node status, he said. However, a proportion of sentinel lymph node biopsies are performed unnecessarily, which means added cost, operating time, and potential diagnostic inaccuracy. The study included 319 women undergoing axillary ultrasound evaluation for primary carcinoma of the breast during a recent 2-year period. The variables recorded for each patient included demographic information, ultrasound findings, tumour characteristics, and the size and number of nodal metastases. The investigators also identified predictors of a sonographic diagnosis and then determined the overall sensitivity, specificity and accuracy of axillary ultrasound, and ultrasound with fine-needle aspiration. Results showed that 30% of women had an abnormal axillary ultrasound. Patients with an abnormal ultrasound were 7 times more likely to have nodal metastases on their final pathology report. Pathologic features associated with an abnormal ultrasound include the number of involved nodes, the size of the metastases, oestrogen receptor, and human epidermal growth factor receptor positivity, the presence of lymphovascular invasion, and tumour grade. Of 75 patients who underwent fine-needle aspiration, 61% were positive with a positive predictive value of 100%. The overall accuracy of axillary ultrasound alone was 73%, and increased to 80% when used in tandem with fine-needle aspiration. The authors said that ultrasound of the axilla is easy to perform and may offer the possibility of avoiding unnecessary nodal dissection. They added that it is a moderately sensitive and highly specific diagnostic modality particularly when combined with fine-needle aspiration. [Presentation title: Usefulness of Preoperative Axillary Ultrasound in Early Stage Breast Cancer Patients. Abstract P43]
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