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

Introduction Axillary ultrasonography (AUS) and US-guided needle core biopsy (NCB) are recommended for evaluating axillary nodal status in new breast cancer cases. Presence of axillary nodal metastasis significantly impacts five-year survival rates. This study evaluated the diagnostic accuracy of preoperative AUS and US‑guided NCB in patients with invasive breast cancer at Leighton Hospital, benchmarked against national NHS standards. The primary objective was to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AUS and NCB in detecting nodal metastasis. Methodology This retrospective study was conducted at the Breast Unit of Leighton Hospital, part of the Mid Cheshire Hospital Trust. The study population included all patients diagnosed and treated for breast cancer from January 1, 2022, to December 31, 2022. Patients presenting with locally advanced, metastatic, or recurrent breast cancer were excluded from the study. Ultrasound evaluations were performed using a high-frequency linear-array transducer (7.5-17 MHz). Patients with in situ disease were not subject to axillary assessment/surgery. Lymph nodes with cortical thickness of 3 mm or more, irregular margins, and effacement of the fatty hilum were considered suspicious and were graded A3 and above. All these patients were subjected to US‑guided NCB. Patients graded A1/A2 and those with biopsy-proven benign nodes had sentinel node biopsy. Patients with positive biopsy for metastatic disease were subjected to axillary lymph node dissection (ALND). Results Axillary assessment for patients graded A3 and above (Group B) met or exceeded NHS standards for sensitivity (0.93), specificity (0.92), and PPV (0.92). NPV (0.92) was slightly below NHS standard. The lower performance metrics in Group B (A1-5) fell short of NHS guidelines in all four metrics, highlighting the need for potential improvements in the diagnostic process or the use of additional diagnostic tools to enhance accuracy. Conclusion Axillary assessment in A3 patients met or exceeded NHS standards, with sensitivity, specificity, and PPV at 0.92, though NPV was slightly lower. A1/A2 patients underperformed across all measures. The findings support AUS as a reliable tool for breast cancer staging and management.