These clinical scenarios represent 40% to 50% of patients treated for breast cancer. The presence of micro metastasis, lobular histology, and lymphovascular invasion has been found to be the independent predictors of false negative results on frozen section. This means that patients who are identified with a node-positive disease by permanent section may require completion of ALND, hence requiring a second procedure, increasing the surgical morbidity. Moreover, the analysis of published data shows that the accuracy of frozen section analysis with a combination of Haematoxylin and Eosin (H&E) staining and immunohistochemistry on sentinel lymph nodes is between 73 to 96%. Furthermore, in order to avoid a second procedure many centers rely on the availability of frozen section analysis of the node. In our part of the world not all the centers have the availability of frozen section analysis. Not only is it expensive and time consuming, SLNB can be complicated by seroma formation, sensory nerve injury, lymphedema and limitation of the range of shoulder motion. However, SLNB also has some morbidity and anesthesia risk. Because of the high morbidity of this procedure, sentinel lymph node biopsy (SLNB) became the standard of care in patients with clinically node-negative breast cancer. Over the years there has been a transition from more radical procedures to conservative approach. Same holds true for the staging and management of axilla. Historically, axillary lymph node staging was performed by means of axillary lymph node dissection (ALND). In patients with breast cancer, axillary lymph node status is an important factor that not only provides prognostic information, but also determines the medical and surgical management options. Positive core biopsy results can thus obviate the need for sentinel lymph node biopsy and allow breast surgeons to directly proceed to axillary lymph node dissection. In conclusion, the present study demonstrated high accuracy of ultrasound-guided axillary lymph node core biopsy in breast cancer patients with clinically node-negative axilla. The sensitivity of ultrasound-guided core biopsy was 88%, specificity 100%, positive predictive values (PPV) 100%, negative predictive values (NPV) 89.28%, diagnostic accuracy 94%. Histopathology result was taken as gold standard. If the result was negative they were subjected to SLNB. These patients underwent axillary lymph node core biopsy. All patients diagnosed with breast cancer (histologically proven) with clinically negative axilla and ipsilateral positive axillary ultrasound were included. This was a non-randomized, prospective interventional study, done at Radiology Department of Aga Khan University Hospital. The aim of the present study is to determine the accuracy and feasibility of ultrasound-guided core biopsy to stage the axilla in clinically node-negative breast cancer patients, comparing with final histopathology as gold standard. However, SLNB is expensive, time consuming, can cause morbidity and can be complicated by seroma formation, sensory nerve injury, lymphedema, etc. Many centers rely on the availability of frozen section on sentinel lymph nodes to avoid a second procedure with the accuracy of procedure ranging from 73 to 96%, however, the availability of frozen section is limited in our part of the world. Pre-operative identification of axillary node positivity in patients with clinically negative nodes by ultrasound imaging of the axilla would allow one-stage axillary clearance and can decrease the need for SLNB from 21% to 70%. Because of the high morbidity of axillary lymph node dissection, sentinel lymph node biopsy (SLNB) became the standard of care in patients with clinically node-negative breast cancer. Historically, in breast cancer patients, axillary lymph node dissection was performed to stage axilla. The aim of the current study is to determine the feasibility and accuracy of ultrasound-guided core biopsy for staging the axilla in clinically node-negative patients with invasive breast cancer.
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