Axillary ultrasound in patients with primary breast cancer

Axillary lymph node status is an important prognostic factor in patients with breast cancer. Traditionally, staging of the axilla was full axillary lymph node dissection (ALND) for all patients with invasive breast cancer. However, ALND is associated with significant morbidity to the patient. To reduce this but offer equal survival outcome as with full axillary dissection, the less invasive surgical sentinel lymph node biopsy (SLNB) for patients with clinical and radiological negative axilla has now become the standard surgical method for staging the axilla. Patients who are sentinel lymph node negative require no further axillary surgery. However, patients with metastatic sentinel lymph nodes may require a completion axillary clearance. To reduce the number of patients having unnecessary surgical SLNB, axillary ultrasound followed by ultrasound-guided core biopsy, or fine needle aspiration cytology (FNAC) of any indeterminate or abnormal nodes is the current method of identifying patients with metastatic lymph nodes preoperatively who can proceed directly to axillary clearance.

Two recent meta-analyses suggest that routine preoperative axillary ultrasound combined with core biopsy or FNAC correctly identify nodal metastases in 50-55% of breast cancer patients. However, one in four patients with a negative axillary ultrasound with or without a biopsy are proven to have metastatic lymph nodes on subsequent SLNB.

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