Identification of Early Breast Cancer Patients with Limited Axillary Disease that Can Be Spared from Routine Axillary Nodal Clearance in Upfront Cases

Abstract

Objective: To compare clinically assessed limited axillary disease with final histopathological findings in breast cancer patients treated surgically as upfront cases and to determine the accuracy of clinical axillary assessment and its implications for contemporary axillary management.

Study Design: Diagnostic cross-sectional study

Place and Duration of Study: Department of Breast Surgery, Combined Military Hospital, Rawalpindi, Pakistan from Feb to Nov 2025.

Methodology: A total of 420 patients were analyzed. Primary variable studied was the accuracy of preoperative clinical axillary assessment in identifying limited axillary disease, using final histopathological nodal status as the gold standard.

Results: The sensitivity of clinical axillary assessment was calculated as 58.0%, specificity was 90.9%, the positive predictive value was 83.8%, while the negative predictive value was 72.8%. The overall diagnostic accuracy of clinical axillary assessment was 76.2%. Agreement between clinically assessed limited axillary disease and final histopathological nodal status was evaluated using Cohen’s kappa statistic. A κ value of 0.50 indicated moderate agreement beyond chance between the two methods (p < 0.001).

Conclusion: This study showed that preoperative clinical and imaging-based axillary assessment showed high specificity but only moderate sensitivity when compared with final histopathology in upfront surgery cases.