Observational studyThe British journal of radiology2026
Less is more: the role of preoperative ultrasound as a risk stratifying tool in identifying low volume axillary disease in breast cancer.
Observational study in The British journal of radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesAxillary lymph node dissection (ALND) in early breast cancer causes lymphoedema in up to 20% of women and may be unnecessary in those with low axillary disease burden. This study evaluates whether preoperative axillary ultrasound (AUS) can stratify nodal burden to support targeted axillary dissection (TAD).
methodsA retrospective single-centre observational study was conducted using records from January 2023 to December 2024. Among 193 patients with abnormal AUS, those with negative axillary biopsy, neoadjuvant therapy, no surgery, or distant metastases were excluded. Data on AUS findings, tumor size, and postoperative nodal histology were collected. Differences between pN1 (<4 positive nodes on ALND) and pN2-3 (≥4 positive nodes on ALND) disease were analyzed using non-parametric and categorical tests.
resultsOf 193 patients, 142 (73.6%) had positive axillary biopsies; 134 were included. Among these, 76 (56.7%) had 1-2 abnormal nodes on AUS. Of 77 evaluable cases, 33 (42.9%) had pN1 and 44 (57.1%) pN2-3 disease. The mean number of abnormal nodes was higher in pN2-3 (3.05 ± 1.85) than pN1 (1.52 ± 0.89; P = .0001). Tumor size was greater in pN2-3 (57.9 ± 33.7 mm) than pN1 (36.5 ± 24.3 mm; P = .0012). AUS performance: sensitivity 87.1%, specificity 55%, PPV 60%, NPV 84.6%, accuracy 69%.
conclusionsAUS effectively identifies patients with low-volume axillary disease preoperatively and can guide TAD, reducing unnecessary ALND. ADVANCES IN KNOWLEDGE: Preoperative AUS with biopsy predicts low-volume nodal disease with high sensitivity and NPV, enabling accurate triage for TAD and avoiding overtreatment.
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