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      Multidetector-row computed tomography for the preoperative evaluation of axillary nodal status in patients with breast cancer.

      Surgery Today

      Adult, Aged, Axilla, Breast Neoplasms, pathology, radiography, Breast Neoplasms, Male, Female, Humans, Lymph Node Excision, Lymph Nodes, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging, Preoperative Care, Retrospective Studies, Sentinel Lymph Node Biopsy, Tomography, X-Ray Computed

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          We evaluated the effectiveness of multidetector-row computed tomography (MD-CT) for detecting axillary lymph nodal status (ALNS) in patients with breast cancer. We reviewed 42 patients with breast cancer. A metastatic lymph node on MD-CT was defined as oval or round, with more than 5 mm on the short axis. We evaluated ALNS preoperatively by both palpation and MD-CT findings and performed sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection (ALND). For establishing the ALNS, MD-CT showed a sensitivity of 76.9%, a specificity of 96.6%, and an accuracy of 90.5%. On the basis of the MD-CT findings, misdiagnosis was made in 4 of the 42 patients, only one of which was false positive. On the other hand, one patient with a histologically negative sentinel lymph node (SLN) result had metastasis only in a non-SLN. Preoperative MD-CT showed a positive node in this patient. Multidetector-row computed tomography assists in identifying women who require ALND without SLNB, with sufficient positive predictive value. False-negative detection by SLNB could be avoided with careful interpretation of the axillary lymph nodes shown by MD-CT.

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