The influence of breast cancer subtypes on axillary ultrasound accuracy: A retrospective single center analysis of 583 women

Eur J Surg Oncol. 2019 Apr;45(4):538-543. doi: 10.1016/j.ejso.2018.10.001. Epub 2018 Oct 10.


Introduction: Axillary ultrasound staging (AUS) is an important tool to guide clinical decisions in breast cancer therapy, especially regarding axillary surgery but also radiation therapy. It is unknown whether biological subtypes influence axillary staging using ultrasound (AUS).

Method: This is a retrospective single center analysis. All patients with breast cancer, a preoperative axillary ultrasound and a complete surgical axillary staging were included between 1999 and 2014, except patients with neoadjuvant chemotherapy (NACT). The results of the AUS were compared with final pathological results. Biological subtypes were identified by immunohistochemistry.

Results: 583 women were included in the study. Sensitivity, Specificity, positive and negative predictive value for AUS were 39%, 96%, 91% and 83%. While sensitivity was significantly lower in Luminal A and B patients (25.0%; 39.8%) as compared to non Luminal breast cancer patients (TN 68.8%; Her2+ 71.4%; p = 0.0032), there were no significant differences between the groups with respect to specificity, PPV and NPV.

Conclusion: Solely regarding sensitivity of AUS, our study could show significant differences between biological subtypes of breast cancer with lower sensitivity in Luminal patients. While PPV was excellent, standing for a low overtreatment rate using AUS for clinical decision making, sensitivity was poor overall, comparable to the results of other studies.

Keywords: Axillary staging; Axillary ultrasound; Biopsy; Immunohistochemical subtypes; Neoadjuvant chemotherapy; Radiotherapy; Sentinel node.

MeSH terms

  • Adult
  • Aged
  • Axilla
  • Breast Neoplasms / metabolism*
  • Breast Neoplasms / pathology*
  • Female
  • Humans
  • Ki-67 Antigen / metabolism
  • Lymph Nodes / diagnostic imaging*
  • Lymph Nodes / pathology*
  • Lymph Nodes / surgery
  • Lymphatic Metastasis
  • Middle Aged
  • Neoplasm Staging
  • Predictive Value of Tests
  • Receptor, ErbB-2 / metabolism
  • Receptors, Estrogen / metabolism
  • Receptors, Progesterone / metabolism
  • Retrospective Studies
  • Sentinel Lymph Node Biopsy
  • Ultrasonography*
  • Young Adult


  • Ki-67 Antigen
  • Receptors, Estrogen
  • Receptors, Progesterone
  • ERBB2 protein, human
  • Receptor, ErbB-2