ROLE OF ULTRASONOGRAPHY TO DETECT AXILLARY NODE INVOLVEMENT IN OPERABLE BREAST-CANCER

Prompted by the concern about unnecessary axillary dissections, we pro spectively studied the accuracy of clinical examination (CE) and conve ntional ultrasonography (USG, 7.5 MHz), to diagnose pre-operatively me tastatic axillary lymph nodes in 200 operable breast cancer patients, USG had higher specificity (90% vs 77%, P = 0.025) and higher positive predictive value (ppv = 90% vs 76%, P = 0.02) than CE. Together, CE USG had higher sensitivity (82% vs 58%, P = 0.00005) and higher negat ive predictive value (npv = 76% vs 58%, P = 0.008) than CE alone, In w omen < 45 years, CE + USG had higher sensitivity (91%, vs 76%, P = 0.0 37) and npv (89% vs 67%, P = 0.018) than in older women. The sensitivi ty and npv of CE + USG to detect > 1 positive node were 97% (for both) in women < 45 years compared to 81% and 79% in older women. The high sensitivity of CE + USG (82% for the whole group) is probably due to t he higher proportion of young women (median age = 45) in our populatio n. It suggests that using CE + USG to avoid axillary dissection in som e patients is feasible.