Staging primary breast cancer. Are there tumour pathological features that correlate with a false-negative axillary ultrasound?

Staging primary breast cancer. Are there tumour pathological features that correlate with a false-negative axillary ultrasound?
S. Johnson, S. Brown, G. Portera, J. Steela, K. Paisleya, R. Watkinsa and C. Holgate
Clinical Radiology 2011 66;6:497-499

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Of 155 women with normal ultrasounds, 45 (29%) were node positive at axillary surgery. Breast tumour size was significantly different with the average size smaller in the true-negative group: 21 versus 30 mm (p < 0.02). The histological type varied significantly between the groups, with more lobular carcinomas in the false-negative group [6/110 (5%) versus 6/45 (13%), p < 0.001]. The false-negative group was also more likely to show lymphovascular invasion in the breast [6/110 (5%) versus 14/45 (31%), p < 0.001]. There was no significant difference in tumour grade or ER status.

The present study has found significant differences in tumour characteristics between women with true-negative and false-negative axillary staging ultrasound in terms of size, primary tumour histological type and presence of lymphovascular invasion. In particular, axillary ultrasound in primary lobular carcinoma may be less accurate and a negative result is more likely to be spurious than with primary ductal carcinomas.

Ultrasound of the axilla: where to look for the sentinel lymph node

Ultrasound of the axilla: where to look for the sentinel lymph node
P. Britton, P. Moyle, J.R. Benson, A. Goud, R. Sinnatamby, S. Barter, M. Gaskarth, E. Provenzano, M. Wallis
Clinical Radiology 2010 65:373–376

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Of 121 patients who underwent axillary ultrasound and CB no malignancy was identified in 73, all of whom subsequently underwent SLNB. Histological evidence of CB in the SLN was identified in 47 (64%) patients. The position of all the lymph nodes identified on ultrasound and the 47 patients whose SLNs were identified were drawn on composite diagrams of the axilla.

Of the 36 nodes identified as sentinel whose position relative to other nodes could be determined, 29 (81%) represented the lowest node identified in the axilla, four (11%) were the second lowest, and three (8%) were the third lowest node. None of the four patients whose CB was from the fourth lowest node had the CB site identified at subsequent SLNB

Ultrasound of the axilla should be carried out in a systematic fashion focusing on level I nodes paying particular attention to the lowest one or two lymph nodes