{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T04:46:25Z","timestamp":1684212385831},"reference-count":14,"publisher":"Royal College of Surgeons of England","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> National UK guidelines suggest that axillary lymph node dissection (ALND) is no longer mandatory for selected early node-positive breast cancer patients. Our study aimed to identify patients with early breast cancer and ultrasound (USS)-positive axillary metastasis who possess low burden of axillary disease and can avoid ALND. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> We conducted a 5-year study of prospectively collected data of patients with clinically T1\u20132, N0 breast cancer and a positive USS-guided axillary biopsy. Primary outcome was involvement of 1\u20132 lymph nodes (low disease burden) or \u22653 lymph nodes (higher axillary disease) on final ALND histology. Tumour type, size, grade, multifocality, receptor status, number of abnormal imaged nodes and presence of lympho-vascular invasion (LVI) were recorded. Data were analysed using chi-squared and Student\u2019s t-test. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> One hundred and sixty-six patients underwent ALND for pT1\u20132 breast cancer. Seventy patients had no clinically palpable lymphadenopathy but a positive USS-guided biopsy. Of 70 patients, 32 women (46%) had low disease burden, whereas 38 women (54%) had higher axillary disease in final histology. LVI and &gt;1 abnormal lymph node on USS were both significantly associated with higher disease burden (p\u00a0=\u00a00.050 and 0.009, respectively). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> Our study confirms the presence of an important patient cohort, who are clinically node-negative with a positive USS-guided biopsy and a low volume of axillary disease. No imaging modality currently has the accuracy required to identify patients with this low disease burden preoperatively but we propose a simple algorithm for axillary management in this subgroup. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2020.7122","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T10:14:57Z","timestamp":1684145697000},"page":"48-52","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-positive axillary lymph nodes in early breast cancer: can a patient subgroup avoid axillary lymph node dissection? 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