Value of Axillary Palpation and Ultrasound, and Axillary Recurrence in Male Breast Cancer: Results of the Registry...

Clinical and sonographic examination of breasts and axillae is standard in breast cancer (BC) care. The aim of this study is to highlight the value of axillary ultrasound in identifying axillary recurrences in male BC, which is still little considered in the literature. This was a registry-based observational multicenter cohort study in Germany. Five hundred and seventy-seven male patients with invasive non-metastatic BC were included. Five hundred and sixty three patients underwent a clinical examination of the axilla, and 500 had an axillary ultrasound. The examination results were used to determine sensitivity and specificity for predicting lymph node metastases depending on the nodal status. The axillary recurrences were determined during follow-up. The sensitivity and specificity were 30.4% and 93.2% for axillary palpation, 42.2% and 88.9% for ultrasound, and 49.5% and 85.3% for both methods combined. Both methods, considered either separately or combined, showed an increase in sensitivity with increasing lymph node involvement. In the combined analysis, the sensitivity varied from 38.5% (pN1) to 80.0% (pN3). Sensitivity was higher in Grade 3 compared to Grades 1 or 2 carcinomas, in patients aged > 68 years compared to younger patients, and in non-obese compared to obese patients (BMI > 30 kg/m²). The axillary recurrence rate was 1.21%. The axillary examination is an important part of pre-therapeutic diagnostics in male patients; however, ultrasound and palpation appear less sensitive than in female disease. The probability of axillary recurrence is very low after adequate therapy in male BC patients without distant metastases and in those with a low risk of metastases based on tumor biology.