Type of publication:
Journal article
Author(s):
Potter S.; Blyuss O.; Cox K.; Davis E.; Dodwell D.; Evans A.; James J.; Lowes S.; McIntosh S.A.; Shaaban A.; Wallis M.G.; Sharma N.; Altaf S.W.N.; Armstrong L.; *Asprou F.; Babu G.; Baig M.; Bell N.; Bhide I.; Blackwell L.; Boyd C.; Brown A.; Coggles L.; Dadnam F.; Dalgliesh D.; Edwards D.; Elmosselhy A.; Elzuber W.; Gray K.; Griffiths A.; Gunarathne D.; Harmouche C.; Iqbal S.; Karatasiou A.; Khadtare K.; Khushbakht S.; Larney T.; Lee Q.Y.; Liew S.; Marriott C.; McMahon M.; Menezes R.; Millington S.; Oeppen R.; Pervez A.; Poolovadoo Y.; Rabone A.; Rainford S.; Reilly M.; Rigby D.-M.; Roychaudhury R.; Saha P.; Savaridas S.; Shannon J.; Sharma S.; Siddiqui S.; Singh S.; Taper J.; Vidyaprakash N.; Walajahi F.; Wilding L.; Wilkinson L.; Wong M.K.; Young P.
Citation:
SSRN. (no pagination), 2026. Date of Publication: 25 Mar 2026.
Abstract:
Purpose To explore the current management of patients with early breast cancer and an abnormal pretreatment axillary ultrasound scan (USS).Methods Consecutive patients with newly diagnosed early breast cancer and an abnormal axillary USS undergoing pretreatment axillary biopsy were included. Simple demographic data and information regarding the number and cortical thickness of abnormal nodes, biopsy performed and results together with primary management and postoperative pathology were collected prospectively. Results were summarised with descriptive statistics and USS findings and pathological data compared. Results Between February 2024 and September 2025, 1,100 patients from 47 UK breast units were included. The median age was 58 (interquartile range (IQR) 48-69); most presented via the symptomatic pathway (n=828, 75.3%). Almost half (n=526, 48.1%) had one abnormal node on USS. Nodes with a median cortical thickness of 4.8mm (IQR 3.6-7.2mm) were sampled, most frequently with core biopsy (n=980, 89.1%). 1,062 (96.5%) participants had a diagnostic biopsy, two-thirds of which were malignant (n=761, 66.2%). No cortical thickness threshold for malignancy was identified. Most patients with a negative axillary biopsy underwent sentinel lymph node biopsy but the management of patients with biopsy-proven node-positive disease was highly variable. There was poor correlation between the burden of axillary disease on USS and surgical pathology, but an USS finding of 1-2 abnormal nodes was the best criterion for identifying patients with pathological pN1 disease. Conclusions Management of patients with biopsy-proven node-positive breast cancer in the UK is highly variable. Evidence-based multidisciplinary guidelines will be essential to standardise and improve patient care.
DOI: 10.64898/2026.03.06.26347693
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