Pre-operative Axillary Staging in Breast Cancer: Implications and Outcome.

Area of Science:

• Oncology
• Radiology
• Surgical Pathology

Background:

• Axillary nodal status is critical for breast cancer prognosis and treatment decisions.
• Axillary ultrasonography (AUS) and US-guided needle core biopsy (NCB) are standard diagnostic tools.
• Evaluating the accuracy of these methods against national benchmarks is essential for quality assurance.

Purpose of the Study:

• To assess the diagnostic accuracy of preoperative AUS and US-guided NCB for axillary nodal metastasis in invasive breast cancer.
• To benchmark the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) against national NHS standards.
• To identify performance variations based on ultrasonographic grading of lymph nodes.

Main Methods:

• Retrospective study of invasive breast cancer patients at Leighton Hospital (2022).
• Exclusion of patients with locally advanced, metastatic, or recurrent disease.
• Lymph node assessment using high-frequency ultrasound with suspicious nodes (cortical thickness ≥3mm, irregular margins) undergoing US-guided NCB.

Main Results:

• For suspicious (A3+) nodes, AUS and NCB met or exceeded NHS standards for sensitivity (0.93), specificity (0.92), and PPV (0.92).
• Negative predictive value (NPV) for suspicious nodes was slightly below the NHS standard (0.92).
• Performance metrics for less suspicious (A1-A2) nodes fell short of NHS guidelines across all measures.

Conclusions:

• Axillary assessment of suspicious lymph nodes (A3+) using AUS and NCB meets or exceeds national standards, supporting its reliability in breast cancer staging.
• Performance in less suspicious lymph nodes (A1-A2) requires improvement, potentially through enhanced diagnostic strategies or tools.
• AUS is a valuable tool for breast cancer staging and management, particularly for suspicious axillary nodes.