Diagnostic Accuracy of Axillary Ultrasonography Compared with Intra-operative Pathological Findings in Patients with Breast Cancer

Document Type : Research Articles


1 Breast Cancer Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

2 School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.


Objective: Breast cancer is the most common cancer and leading cause of mortality in women worldwide. Diagnosis of
axillary lymph node involvement, frequently by axillary ultrasonography (AUS), is an important step in patients with
primary breast cancer, while the gold standard pathological examination is only applicable during surgery. Thus,
we aimed to evaluate the predictive value of AUS in detection of lymph node involvement. Methods: A total of 56
patients with primary breast cancer, who were candidate of mastectomy were included in this study. A single radiologist
performed pre-operative axillary sonography for all the patients and reported the results in a checklist. The results
were then compared with intra-operative pathological results of lymph node dissection to evaluate the sensitivity,
specificity, positive and negative predictive values of AUS in detection of the disease. Result: The results showed that
pre-operative AUS had a sensitivity of 63.3%, specificity of 84.6%, positive predictive value of 82.6%, and negative
predictive value of 66.6%. Correlation between axillary lymph node characteristics revealed that the absence of fatty
hilum, cortical thickness, and loss of ovality of the lymph nodes were the most specific factors in detection of lymph
nodes’ involvement. Conclusion: AUS has a low sensitivity and cannot determine the presence of micro-metastases
and suspicious lymph nodes accurately in early stages of the disease, and it seems that defining new parameters may
help for increasing the sensitivity and specificity of the axillary lymph node sonography. Apparently, pathological
examination remains the gold standard diagnostic method.


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