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Purpose <p>To evaluate the diagnostic accuracy of post-neoadjuvant chemotherapy (NACT) axillary ultrasound in detecting residual nodal disease and its role in guiding axillary surgical decision-making.</p> Methods <p>This retrospective diagnostic accuracy study included consecutive breast cancer patients who completed NACT and underwent surgery between January 2022 and December 2024. Post-NACT axillary ultrasound findings were compared with final histopathology. Sensitivity, specificity, predictive values, likelihood ratios, and receiver operating characteristic (ROC) analysis were calculated.</p> Results <p>A total of 301 patients were included, of whom 100 (33.2%) had residual nodal disease. Post-NACT axillary ultrasound demonstrated a sensitivity of 77.0% (95% CI 67.6–84.7), specificity of 79.1% (95% CI 72.8–84.6), positive predictive value of 64.7% (95% CI 55.5–73.2), and negative predictive value of 87.4% (95% CI 81.7–91.8), with an overall accuracy of 78.4%. The area under the curve was 0.78, indicating moderate diagnostic performance. Twenty-three patients (13%) with residual nodal disease were misclassified as node-negative.</p> Conclusion <p>Post-NACT axillary ultrasound demonstrates moderate diagnostic accuracy with a relatively high negative predictive value but a clinically relevant false-negative rate. It may serve as a triage tool in selected patients; however, it should be integrated with surgical staging strategies to ensure oncologic safety.</p>

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Diagnostic Accuracy of Post-neoadjuvant Axillary Ultrasound for Detecting Residual Nodal Disease in Breast Cancer: A Retrospective Single-centre Study

  • 期刊论文

  • 发表日期：

    2026年5月8日

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  • Debashri Shankarraman,
  • Geethapriya Sivaramalingam,
  • Nandini Govindarajan,
  • Saranya Parthasarathy,
  • Balapriya B S,
  • Selvi Radhakrishna

摘要

Purpose

To evaluate the diagnostic accuracy of post-neoadjuvant chemotherapy (NACT) axillary ultrasound in detecting residual nodal disease and its role in guiding axillary surgical decision-making.

Methods

This retrospective diagnostic accuracy study included consecutive breast cancer patients who completed NACT and underwent surgery between January 2022 and December 2024. Post-NACT axillary ultrasound findings were compared with final histopathology. Sensitivity, specificity, predictive values, likelihood ratios, and receiver operating characteristic (ROC) analysis were calculated.

Results

A total of 301 patients were included, of whom 100 (33.2%) had residual nodal disease. Post-NACT axillary ultrasound demonstrated a sensitivity of 77.0% (95% CI 67.6–84.7), specificity of 79.1% (95% CI 72.8–84.6), positive predictive value of 64.7% (95% CI 55.5–73.2), and negative predictive value of 87.4% (95% CI 81.7–91.8), with an overall accuracy of 78.4%. The area under the curve was 0.78, indicating moderate diagnostic performance. Twenty-three patients (13%) with residual nodal disease were misclassified as node-negative.

Conclusion

Post-NACT axillary ultrasound demonstrates moderate diagnostic accuracy with a relatively high negative predictive value but a clinically relevant false-negative rate. It may serve as a triage tool in selected patients; however, it should be integrated with surgical staging strategies to ensure oncologic safety.