Ultrasound Accuracy in Detection of Metastatic Axillary Lymph Nodes in Breast Cancer after Neoadjuvant Chemotherapy

Background: In the present paper, the main diagnostic tool for re-evaluation of axillary lymph node involvement and planning of surgery after neoadjuvant chemotherapy (NAC) is ultrasound whose accuracy we aimed to determine herein. The high precision of ultrasound in diagnosis of metastatic axillary lymph nodes in untreated patients is well known; however, its worth in patients who received NAC is highly controversial.Method: We enrolled ۱۶۵ breast cancer patients receiving NAC in this retrospective cohort study. They all had undergone post-NAC ultrasound done before surgery. The ultrasound reports were reassessed and validated by a breast radiologist. Finally, the histopathology reports were compared to those of the ultrasound.Results: Among ۱۶۵ surveyed post-NAC ultrasounds, ۵۳ women had positive results and ۱۱۲ had negative results. Pathology and ultrasound reports were accordant in ۹۳ women and adverse in ۱۱۲ others. The false negative rate of post-NAC axillary ultrasound was calculated as ۶۰.۶%. The sensitivity and specificity of post-NAC AxUS were ۳۹.۴% and ۷۹%, respectively. After NAC, there were certain changes in ultrasound reports from positive to negative in ۵۰% and pathologic complete clearance was observed in just ۲۸% of the women who were initially clinically lymph node positive.Conclusion: Ultrasound was not found to be an accurate and appropriate tool for evaluation of axillary lymph node involvement in breast cancer patients who receive NAC. By changing the primarily established surgical plan from ALND to SLNB, based on the ultrasound findings, patients may remain undertreated. Furthermore, the axillary nodes pathologic clearance after NAC was observed in less than one third of the women who were initially clinically node positive; accordingly, surgeons should be cautious about the optimum response of axillary metastatic lymph nodes to NAC.

کلیدواژه ها:

Ultrasound precision ، NAC ، Axillary downstaging ، Lymph node involvement ، Breast chemotherapy