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The aim was to evaluate the diagnostic performance of preoperative axillary ultrasound (US) and breast MRI for differentiation between pN1 and pN2\u20133 in clinically node-positive breast cancer. A total of 49 patients were included with axillary metastasis confirmed by US-guided tissue sampling. All had undergone breast MRI between 2008\u20132014 and subsequent axillary lymph node dissection. Unenhanced T2-weighted MRI exams were reviewed by two radiologists independently. Each lymph node on the MRI exams was scored using a confidence scale (0\u20134) and compared with histopathology. Diagnostic performance parameters were calculated for differentiation between pN1 and pN2\u20133. Interobserver agreement was determined using Cohen\u2019s kappa coefficient. At final histopathology, 67.3% (33\/49) and 32.7% (16\/49) of patients were pN1 and pN2\u20133, respectively. Breast MRI was comparable to US in terms of accuracy (MRI reader 1 vs US, 71.4% vs 69.4%, p\u2009=\u20090.99; MRI reader 2 vs US, 73.5% vs 69.4%, p\u2009=\u20090.77). In the case of 1\u20133 suspicious lymph nodes, pN2\u20133 was observed in 30.4% on US (positive predictive value (PPV) 69.6%) and in 22.2\u201324.3% on MRI (PPV 75.7\u201377.8%). In the case of \u22654 suspicious lymph nodes, pN1 was observed in 33.3% on US (negative predictive value (NPV) 66.7%) and in 38.5\u201341.7% on MRI (NPV 58.3\u201361.5%). Interobserver agreement was considered good (k\u2009=\u20090.73). In clinically node-positive patients, the diagnostic performance of axillary US and breast MRI is comparable and limited for accurate differentiation between pN1 and pN2\u20133. Therefore, there seems no added clinical value of preoperative breast MRI regarding nodal staging in patients with positive axillary US.<\/jats:p>","DOI":"10.1038\/s41598-019-54017-0","type":"journal-article","created":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T11:02:49Z","timestamp":1574679769000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Diagnostic performance of axillary ultrasound and standard breast MRI for differentiation between limited and advanced axillary nodal disease in clinically node-positive breast cancer patients"],"prefix":"10.1038","volume":"9","author":[{"given":"S.","family":"Samiei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. J. A.","family":"van Nijnatten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. 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