Avoiding unnecessary sentinel node biopsy
© BioMed Central 2006
Published: 10 July 2006
Sentinel node biopsy is a surgical technique that identifies the first axillary node to which a breast tumour drains directly. If positive, node clearance is performed as a secondary procedure. Prior knowledge of metastatic lymphadenopathy allows primary axillary node clearance, avoiding the associated financial and psychological costs of two surgical procedures.
A retrospective study of primary breast cancer patients treated in Hope Hospital Breast Unit between April 2004 and March 2005 was performed to assess the efficacy of axillary ultrasound and clinical examination in assessing axillary node status.
Of 96 patients with 97 cancers identified, 69 had ipsilateral axillary ultrasound. Eight patients were excluded because axillary surgery was not performed.
The sensitivity of axillary palpation alone in detecting metastatic nodes was 50%, the specificity was 93%, the PPV was 87% and the NPV was 68%. For axillary ultrasound alone, the sensitivity was 72%, the specificity was 88%, the PPV was 84% and the NPV was 78%. The combination of clinical and ultrasound examination predicted metastases with sensitivity 79%, specificity 84%, PPV 82% and NPV 82%. Combining clinical examination and ultrasound missed only 10% of metastatic nodes. In another 8% of cases, ultrasound or axillary palpation was falsely positive and FNA of these nodes could have reduced the risk.
Palpable nodes? (six not recorded)
Either nodes palpable or ultrasound positive?