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Abstract
Traditionally, axillary lymph node status, in the absence of distant metastasis, is the single most important prognostic factor for overall survival, staging and treatment planning in women with early-stage breast cancer and is critical in the planning of systemic adjuvant therapy However, axillary lymph node dissection (ALND) has been associated
with substantial cost and morbidity, including seroma formation, lymphedema, sensory numbness, and limitations in arm motion and strength, Women who experience breast cancer–related lymphedema have a measurable decrease in quality of life compared with women without lymphedema. Currently, many centers use sonographic evaluation in the setting of a highly suspicious breast mass, but few do perform detailed measurements or Doppler evaluation. In present series, measurement of the maximum lymph node cortex thickness and other characteristics of the US axillary lymph node examination improve sensitivity and specificity results. Ultrasonography can easily reveal a centric-echogenic area, corresponding to the hilus and surrounding fatty tissue, in the homogeneously hypoechoic node. When identifying a lymph node using AUS, only lymph nodes with diameters 1.0 cm are considered to show potentially massive to extensive nodal involvementSummary and conclusion
- 134 Many diagnostic criteria have been used to identify abnormal lymph nodes, including the following: size, shape, focal doubling of the cortical thickness, and cortical morphology. In present work, several criteria have been used to define positive axillary sonography including Longitudinal-
Transverse Ratio<2. H / L Ratio < 50%, , partial or total loss of fatty hilum and bullous and/ or thickened cortex. High-resolution and Doppler ultrasonography have been reported to be both more sensitive and more specific than standard ultrasonography in the detection of axillary metastases, with sensitivities ranging from 70% to 84% and specificity of 98%.< When using high-resolution US, with or without USFNA, published sensitivity ranges from 50% to 92%, specificity ranges from 90% to 100%,
and accuracy ranges from 76% to92%. Preoperative axillary sonography is an useful diagnostic method even when done routinely. If further criteria are considered, axillary dissection could be avoided in some patients In our work, there is significant agreement between the findings on ultrasound-guided FNA biopsy of the axilla and findings on final pathological evaluation of the axilla and the possibility of detection of positive axillary nodes by US is significantly higher with higher number of positive Nodes and/or axillary node ratio in final pathology High-resolution and Doppler ultrasonography have been reported to be both more sensitive and more specific than standard ultrasonography in the detection of axillary metastases, with sensitivities ranging from 70% to 84%<and specificity of 98%.