Published: 2022-05-24

Evaluation and correlation of clinicopathological and radiological findings of axillary node positivity in clinically node negative carcinoma breast

Himanshu Sekhar Kand, Minati Mohapatra, Srikant Panda, Ashok Kumar Sarangi, K. Kiran Babu, Anshuman Sarangi


Background: In 2015, there will be an estimated 155,000 new cases of breast cancer and about 76,000 women in India are expected to die of the disease. By the time a breast lump becomes palpable for clinical detection, it is usually advanced. We conducted a study to compare the status of axillary lymph node between the radiological and histopathological finding with the clinically negative lymph mode in carcinoma breast in order to limit the axillary lymph node dissection.

Methods: This prospective study 50 female patients of carcinoma breast freshly detected and those with non-palpable axillary lymph admitted in S.C.B M.C.H, Cuttack, were included in the study.

Results: The mean age of the patients was 51.26 years with standard deviation of 12.26 years with a range of 20 to 80 years. All 50 cases included in the study was done mammography of both breast and among them BIRADS IV 18 cases, BIRADS V 19 cases, BIRADS VI 5 cases and 08 cases were benign. 44 (88%) patients had Karnofsky performance score of 90-100 and 6 (12%) patients had score of 80-90. None (0.00%) of the patients had <80 performance score. Out of the 50 cases enrolled in the study, 04 were underwent wide local excision, 09 were breast conservation surgery and 37 were modified radical mastectomy along with axillary clearance.

Conclusions: Higher sensitivity due to axillary ultrasound helps to reduce surgery time as patients with positive axillary lymph nodes directly get an Axillary Lymph Node Dissection (ALND) without preceding Sentinel lymph node biopsy (SLNB).


Breast cancer, Axillary lymph node, Mammography, Computed tomography

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Parkin DM, Bray F, Ferlay J, Pisani P. Estimates the world cancer burden. Globocon 2000. Int J cancer. 2001;94:153-6.

Gupta RK, Hutchison AG, Dowlow CS. Fine needle aspiration in cytodiagnosis of breast masses in pregnant and lactating women and its inpact on management. Diagn. Cytopathol. 1993;9:156-9.

Duffy MJ. Predictive markers in breast and other cancers. Clin Chem. 2005;51:494-503.

Isaacs C, Stearns V, Hayes DF. New prognostic factors for breast cancer. Semin Oncol. 2001;28:53-67.

Duffy MJ. Urokinase plasminogen activator and its inhibitor, PAI-1, as prognostic markers in breast cancer: from pilot to level 1 evidence studies. Clin Chem. 2002;48:1194-7.

Yang M, Moriya T, Oguma M, Cruz CDL, Endoh M, Ishida T et al. Microinvasive ductal carcinoma (T1mic) of the breast. The clinicopathological profile and immunohistochemical features of 28 cases. Pathol Int. 2003;53(7):422-8.

Carney WP, Neuman R, Lipton A, Price C. Potential clinical utility of serum HER-2/neu oncoprotein concentrations in patients with breast cancer. Clin Chem. 2003;49:1579-98.

Jung J, Park H, Park J, Kim H. Accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology for axillary staging in breast cancer. J Surg. 2010;80(4):271-5.

Ertan K, Linsler C, Liberto AD, Ong MF, Solomayer E, Endrikat J. Axillary ultrasound for breast cancer staging: an attempt to identify clinical/histopathological factors impacting diagnostic performance. Breast Cancer (Auckl). 2013;7:35-40.

Garcia-Ortega MJ, Benito MA, Vahamonde EF, Torres PR, Velasco AB, Paredes MM. Pretreatment axillary ultrasonography and core biopsy in patients with suspected breast cancer: Diagnostic accuracy and impact on management. Eur J Radiol. 2011;79(1):64-72.

Mills P, Sever A, Weeks J, Fish D, Jones S, Jones P. Axillary Ultrasound Assessment in Primary Breast Cancer: An Audit of 653 Cases. Breast J. 2010;16(5):460-46.

Vaidya JS, Vyas JJ, Thakur MH, Khandelwal KC, Mittra I. Role of ultrasonography to detect axillary node involvement in operable breast cancer. Eur J Surg Oncol. 1996;22(2):140-3.

Das A, Khanna R, Meena RN, Shukla RC, Kumar M, Khanna S. Doppler Ultrasound Evaluation of the Axilla in Clinically Node Negative Breast Cancer. World Journal of Surgical Medical and Radiation Oncology. 2012;3.

Kebudi A, Calişkan C, Yetkin G, Celebi S, Işgör A, Halefoğlu AM et al. The role of pre-operative B mode ultrasound in the evaluation of the axillary lymph node metastases in the initial staging of breast carcinoma. Acta Chir Belg. 2005;105:511-4.

Strauss HG, Lampe D, Methfessel G, Buchmann J. Preoperative axillary sonography in breast tumor suspected of malignancy—a diagnostic advantage? Ultraschall Med. 1998;19(2):70-7.

Yang WT, Ahuja A, Tang A, Suen M, King W, Metreweli C. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med. 1996;15(3):241-6.

Bonnema J, van Geel AN, van Ooijen B, Mali SP, Tjiam SL, Henzen-Logmans SC et al. Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method. World J Sur. 1997;21(3):270-4.

Bedrosian I, Bedi D, Kuerer HM. Impact of clinicopathologi¬cal factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. A Surg Onc. 2003;10(9):1025-30.

Aitken E, Osman M. Factors affecting nodal status in invasive breast cancer: a retrospective analysis of 623 patients. Breast J. 2010;16(3):271-8.

Susini T, Nori J, Olivieri S, Molino C, Marini G, Bianchi S et al. Predicting the status of axillary lymph nodes in breast cancer: a multiparameter approach including axillary ultrasound scanning. Breast. 2009;18(2):103-8.

Vassallo P, Wernecke K, Roos N, Peters PE. Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology. 1992;183(1):215-20.

Raza S. Axillary adenopathy. In: Berg W, ed. Diagnostic Imaging: Breast. Vol. IV. Salt Lake City, UT: Amirsys; 2008:30-31.