%0 Journal Article
%T Accuracy of Individual Descriptors and Grading of Nodal Involvement by Axillary Ultrasound in Patients of Breast Cancer
%A Navneet Kaur
%A Pradeep Sharma
%A Akhil Garg
%A Anupama Tandon
%J International Journal of Breast Cancer
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/930596
%X Background. Four-node sampling is a useful substitute for sentinel node biopsy in low resource settings. USG is being increasingly used as a preoperative tool to evaluate axilla. We conducted this study to assess the accuracy of different descriptors of axillary ultrasound and to formulate a model on grading of axillary involvement. Material and Methods. Thirty-four patients with clinically negative axilla underwent preoperative axillary ultrasound. The suspicious nodes were marked and details of various descriptors were noted. These nodes were sampled during axillary dissection and correlation of ultrasonographic findings with histopathological report was done to calculate accuracy of different descriptors. Based on this, a grading system of axillary lymph nodes involvement was formulated. Results. Based on the presence of various descriptors, five grades of nodal involvement could be defined. The most accurate descriptors to indicate nodal involvement were loss of hilar fat and hypoechoic internal echoes with specificity of 83% and positive predictive value of 92% each. The combination of descriptors of round shape with loss of hilar fat and hypoechoic internal echos had 100% specificity and positive predictive value. Conclusions. Grading of nodal involvement on axillary USG can be useful for selecting the most suspicious nodes for sampling during axillary dissection. 1. Introduction Metastatic involvement of axillary lymph node is the single most important prognostic factor in breast cancer. The presence of axillary involvement in breast cancer determines the patient¡¯s survival and staging of the disease and plays an important part in local control. Until recently, axillary lymph node (ALND) dissection was considered as the reference method for detecting lymph node involvement. However the rate of axillary lymph node metastasis is very low in patients diagnosed at an early stage [1, 2]. Hence studies in the last decade discourage the use of ALND because of significant associated morbidities such as lymphedema, paresthesias, infection, and decreased range of movement of shoulder. To avoid these unnecessary morbidities the concept of sentinel node biopsy (SLNB) has gained increasing acceptance. Studies have proved that the drainage of breast lymphatics is in an orderly manner through initial node(s)¡ªthe sentinel lymph node (SLN) and almost 100% of breast cancer drain to axilla irrespective of the primary tumor¡¯s location [3]. Studies have proved that SLND alone is sufficient for management of axilla in early cancers if SLN is negative [4, 5]. However
%U http://www.hindawi.com/journals/ijbc/2013/930596/