Clinico Pathological Assessment of Non Palpable Axillary Lymph Nodes in Early Breast Cancer

Background: Axillary lymph node status is a significant prognostic pathological factor in patients with operable primary breast cancer. Axillary staging allows loco-regional control and provides relevant information to direct adjuvant systemic therapy. Methods: 30 patients fulfilling inclusion criteria were prospectively studied. Clinico pathological characteristics were assessed and the performance of AUS and AUS guided biopsy for staging the axilla was summarized using sensitivities and specificities, treating the final histopathologic findings as the true status ascertaining the presence or absence of nodal metastases. Results: The mean age of study participants was 47.8yrs, the mean duration of tumour was 3.2 months and the mean size of tumour was 3.25cm. 46.7% of the patients had lump in the upper outer quadrant. On postoperative histopathological examination, 27 patients had invasive ductal carcinoma – not otherwise specified and 14 patients had metastasis in 1-3 ipsilateral axillary lymph nodes. The sensitivity and specificity of AUS was 64.7% and 84.6% respectively and the sensitivity and specificity of AUS guided FNAC was 82.3% and 100% respectively. Conclusions: In our study, tumour size, quadrant and duration significantly affected the status of axillary nodal metastasis but not the age, menopausal status, family history and breastfeeding. AUS guided FNAC is highly specific for assessing nodal metastasis, plays a role in sparing SLNB in early breast cancer and in triaging cases for adjuvant systemic therapy. Our results support the routine use of AUS and AUS guided FNAC for preoperative evaluation in early breast cancer.