Prognostic Role of Preoperative Axillary Ultrasound for Lymph Node Metastasis and Recurrence in Early Stage Breast Cancers
- Author:
Han Song MUN
1
;
Eun Young KO
;
Boo-Kyung HAN
;
Eun Sook KO
;
Ji Soo CHOI
;
Sang Hee KIM
Author Information
- Publication Type:Original Article
- From:Journal of Breast Cancer 2025;28(6):393-405
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Evaluating the role of preoperative axillary ultrasound (US) in early-stage, clinically node-negative breast cancer, focusing on its ability to predict nodal metastasis and long-term recurrence.
Methods:This retrospective study included patients with T1–T2 clinically node-negative breast cancer who underwent preoperative axillary US and surgery between January and December 2009. Based on US findings, patients were classified as US-positive (presence of suspicious nodes, such as cortical thickening or absent fatty hilum) or US-negative.Clinicopathological features and recurrence outcomes were analyzed using the χ2 test, Cox proportional hazards regression, and Kaplan–Meier survival analysis.
Results:Among 878 women (mean age, 49 ± 9 years), 234 were US-positive and 644 were US-negative; 283 patients were pathologic node-positive (pN ≥ 1) and 595 were node-negative (pN0). Preoperative axillary US demonstrated a sensitivity of 42.4% (95% confidence interval [CI], 36.8–48.2); specificity, 80.8% (95% CI, 77.5–83.8); positive predictive value, 51.3% (95% CI, 44.9–57.6); and negative predictive value, 74.7% (95% CI, 71.2–77.9). The US-positive group had a higher rate of axillary lymph node dissection (62.8% vs. 32.8%), greater mean number of metastatic nodes (2.6 vs. 0.5), and higher proportion of macrometastasis (94.2% vs. 71.8%) compared with the US-negative group (all p < 0.001). The 10-year recurrencefree survival was lowest in the pN-positive/US-positive group (90.3%; 95% CI, 82.7–94.7), intermediate in the pN-positive/US-negative group (92.4%; 95% CI, 86.7–95.7), and highest in the pN-negative group (97.4%; 95% CI, 95.4–98.5) (log-rank p < 0.001).
Conclusion:Preoperative axillary US might help assess lymph node metastasis in clinically node-negative patients. Moreover, US positivity was associated with an increased risk of long-term recurrence.
