Diagnostic Significance of Preoperative Axillary Staging in Breast Cancer

BACKGROUND: The axillary lymph node status is one of the most relevant prognostic factors in breast cancer. The noninvasive investigation of axillary lymph node involvement in the preoperative diagnosis is one of the greatest challenges in the treatment of breast cancer. The aim of our study is to assess the significance of preoperative axillary diagnostics. It will be verified whether the axillary ultrasound, the fine needle aspiration or biopsy of suspicious lymph nodes can safely predict the axillary metastasis. METHODS: The combination of the clinical examination of the axilla, the axillary ultrasound and ultrasound-guided fine needle aspiration or biopsy were performed for preoperative axillary staging and the planning of further treatment between January 2010 and December 2012 in 586 patients with breast cancer and carcinoma in situ in our hospital. RESULTS: The axillary ultrasound showed a low positive predictive value (61%). It follows that unsuspicious ultrasound findings can not definitely exclude axillary lymph node metastasis. The sensitivity for the detection of malignancy is only at 62 %, which is why the axillary ultrasound alone has not proven to be sufficiently precise. The axillary ultrasound in combination with an ultrasoundguided fine needle aspiration or biopsy has shown a sensitivity of 77%. It is easy to perform and, by this method, surgical procedures could be avoided in case of contraindications for sentinel node biopsy or in inoperable patients with breast cancer. Elderly patients with small (<= 2 cm), estrogen receptor-positive and clinically node-negative breast cancer, which will receive endocrine therapy, could be successfully treated without surgical intervention. CONCLUSION: Our data for preoperative axillary staging have shown that ultrasound-guided fine needle aspiration is a useful and reliable preoperative axillary diagnostic.