Axillary burden of disease following false-negative preoperative axillary evaluation

Am J Surg. 2014 Oct;208(4):577-81. doi: 10.1016/j.amjsurg.2014.05.015. Epub 2014 Jul 23.

Abstract

Background: Preoperative axillary ultrasound (AUS) and fine-needle aspiration (FNA) are sensitive and specific for breast cancer nodal metastases. We hypothesize that false-negative result predicts minimal axillary disease (≤2 +nodes).

Methods: A retrospective review of breast cancer patients receiving AUS identified T1/T2 tumors and positive sentinel node with axillary dissection. Chi-square analysis was performed using Fisher's exact test.

Results: Of 903 AUS cases, 384 had T1/T2 tumors. False-negative rate of AUS ± FNA was 48% and 45%, respectively. Of 384 cases, 73 were sentinel node positive and had axillary dissection; 55 (75.3%) were invasive ductal carcinoma (IDC). Negative predictive value for greater than or equal to 2 nodes was 71% in IDC versus 44% for in non-IDC patients. Sixteen (29.0%) IDC patients had greater than or equal to 3 positive nodes versus 10 (55.5%) non-IDC (P = .05) patients.

Conclusion: The high negative predictive value for AUS with FNA for IDC suggests that the AUS plus FNA interpretation may be better limited to the ipsilateral nodes of IDC.

Keywords: Axillary ultrasound; False negative; Pathologic burden.

Publication types

  • Comparative Study

MeSH terms

  • Axilla
  • Biopsy, Fine-Needle / methods*
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / secondary*
  • Breast Neoplasms / surgery
  • Diagnosis, Differential
  • False Negative Reactions
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Node Excision
  • Lymph Nodes / diagnostic imaging*
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Neoplasm Staging / methods
  • Predictive Value of Tests
  • Preoperative Period
  • Retrospective Studies
  • Sentinel Lymph Node Biopsy / methods*
  • Ultrasonography