Clinico - pathological profile of axillary lymph node status in early breast carcinoma - a tertiary care centre experience
Keywords:Axilla, Breast cancer, Lymph nodes, Palpation, TNM staging
Background:Surgical dissection is the accepted mode of staging the axilla in breast cancer. However, the associated morbidity has led researchers to look at less invasive options like sentinel lymph node biopsy. Proper prediction of axillary node positivity can help towards stratifying patients for dissection or sentinel biopsy. The primary objective of the study was to assess the factors influencing pathological axillary lymph node positivity in early carcinoma breast. Secondary objective was to assess the reliability of clinical evaluation of axillary lymph nodes in these patients.
Methods: This was an Observation study, conducted from January 2012 to December 2014, at Government Medical College Hospital, Trivandrum, Kerala, India. 100 Consecutive cases of early carcinoma breast admitted in the general surgery wards during this period were included in this study.
Results:Axillary lymph node positivity was found to be more in younger age group, pre-menopausal patients, lobular pathology, and HER 2 neu positive patients. Premenopausal women and outer quadrants tumours have more axillary lymph node positivity. Clinical palpation for axillary lymph nodes was found to have a sensitivity of 58.18%, specificity of 62.22%, and positive predictive value of 65.31% and negative predictive value of 54.9%.
Conclusions:Younger age, HER 2 neu positivity and higher histological grade are associated with more risk of axillary disease. Also, the clinical examination of axillary lymph nodes is associated with significant false negative and false positive rates in early breast carcinoma. Axillary involvement and thus the need for loco-regional treatment can be predicted from the patients' clinico-pathological characteristics.