Radiopathological correlation in ultrasound findings and locoregional involvement of axillary lymph nodes in breast cancer.

Abstract

Breast carcinoma is the malignant neoplastic proliferation of breast tissue cells. When it crosses the basal membrane, invades vessels and reaches regional lymph nodes and/or remote areas, we speak of an invasive infiltrating carcinoma. Sentinel lymph node (SLN) biopsy is the most widely used method to confirm the diagnosis, followed by ultrasound, fine needle aspiration or core needle biopsy. Our objective was to analyze the radiopathological evaluation between the ultrasound characteristics of the axillary nodes, following the classification of Bedi (2008), and the findings in SLN biopsy.

Cross-sectional study, in which a total of 41 female patients with an average age of 70.4 years, diagnosed with breast cancer between 2018 and 2023, were analyzed. The patients had undergone breast and axillary ultrasound studies and SLN biopsy. Ultrasound nodes were categorized as low, medium, and highly suspicious according to the Bedi classification, taking focal hypoechoic cortical thickening (>3 mm) with total hilar replacement as highly suspicious morphological criteria. This classification was chosen because of its easy clinical applicability.

17 positive ultrasound scans with findings suggestive of metastatic condition were found. Then, they were classified according to Bedi, obtaining 5 patients with a slight degree of suspicion, 3 with a medium degree of suspicion, and 9 patients with a high degree of suspicion. In addition, of the total number of patients, 5 did not present SLN, 20 presented only one positive SLN, 8 two SLNs, and 8 more than three SLNs, with the highest value found being 9 positive nodes. It is important to highlight the proportional classification between axillary nodes according to the Bedi classification and the number of positive nodes found in sentinel node biopsy; the number of the latter being greater when there is greater ultrasound suspicion.

We conclude that due to the low negative predictive value (13%) of ultrasound, the gold standard for the diagnosis of breast cancer continues to be the intraoperative sentinel node technique. However, the axillary ultrasound technique is of vital importance thanks to the simplicity of its performance in economic and humanistic terms, since it is a non-invasive method.