Utility of Preoperative Staging of Ipsilateral Axilla with Ultrasound and Guided Needle Aspiration in Early-Stage Breast Cancer—Current Indian Scenario

Clinical assessment of the axilla, especially in early-stage breast cancer, can have a high degree of inaccuracy with over-staging curtailing the use of sentinel node biopsy. Imaging of axilla, using ultrasound ± guided fine needle aspiration cytology (FNAC) can help in better staging. In this study, we aim to compare physical examination and ultrasound of axilla and FNAC and assess their accuracy in preoperative staging of axilla. This was a prospective observational study. Patients with biopsy-proven invasive early-stage breast carcinoma, consenting to be part of the study, underwent ultrasound (US) of ipsilateral axilla with guided FNAC, when indicated and underwent surgery which included complete axillary dissection. Postoperative histopathology was compared to preoperative US and guided cytology (if done), to correlate the latter’s efficacy in detecting positive axillary nodes. Clinically, 96% of patients had palpable axillary nodes, though of doubtful significance. On US axilla, 62% had suspicious nodes (guided FNAC was performed). Sensitivity and specificity of US axilla was 90.9% and 60.7%, with sensitivity reaching 100% in patients with > 1 node positive, while that of US + FNAC was 85.7 and 100% respectively. Although all US nodal parameters studied showed positive correlation with final nodal pathology (p < 0.005), loss of fatty hilum was the best predictor of metastatic nodal disease. Preoperative ultrasound of ipsilateral axilla ± FNAC helps in better preoperative staging of axilla. Its routine use can help reduce the false positivity of clinical examination and help in avoiding unnecessary axillary dissection and also in better selection of patients for sentinel node biopsy.