The Sensitivity and Specificity of Preoperative Staging of Axillary Nodes in Cancer Breast Patients

Aims: Metastasis to axillary lymph nodes is an important prognostic factor in carcinoma breast patients, with implications on overall survival and progression-free survival. To evaluate the accuracy of pre-operative clinical palpation and USG axilla in patients with carcinoma breast, using histopathology as the gold standard.

Study Design: Cross-sectional observational study.

Place and Duration of Study: This was a retrospective study, carried out at Cancer Research Institute, SRHU, India, between January 2015 and December 2018.

Methodology: Data was collected from Case records and Hospital Information System for patients having undergone surgery for breast cancer. Pre-treatment clinical, ultrasound axilla, and final histopathology details were recorded. Taking histopathology as the gold standard test, diagnostic accuracy of clinical palpation and ultrasound axilla was calculated.

Results: 256 patients were enrolled in the study. Clinically, 70.7% of patients were T1/T2 stage, 53.9% were node-positive, on USG axilla 59% had abnormal nodes, pathologically 53.52% had nodal metastasis. The sensitivity, specificity for clinical palpation was 77.86% and 75%, for USG was 90.71% and 79.31%. Sensitivity and specificity of USG in c T1/2 was 88.64% and 80.21%; in c T3/4 94.23% and 65.22%; in c N negative 87% and 72.16%; in c N positive 91.74% and 75.86%.

Conclusion: The diagnostic accuracy of clinical palpation of axilla alone was low; Ultrasound axilla had high sensitivity but low specificity across all T stages of breast tumor. The ultrasound had a high negative predictive value in clinically non-palpable nodes and a high positive predictive value in clinically palpable nodes.