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Abstract
Background: Axillary staging guides treatment in early breast cancer. In low-risk patients, routine intraoperative frozen section may be unnecessary, and preoperative axillary ultrasound could help identify those who can safely avoid it.
Objective: To evaluate whether axillary ultrasound findings, particularly cortical thickness and nodal morphology, predict sentinel lymph node metastasis and support selective omission of intraoperative frozen section.
Methods: This prospective pilot feasibility study included 26 patients with early-stage breast cancer from August 2025 to January 2026. Preoperative axillary ultrasound assessed cortical thickness and nodal morphology. Nodes with cortical thickness ≥0.3 cm underwent ultrasound-guided core biopsy; those <0.3 cm were considered benign. All patients underwent SLNB with intraoperative FS. Associations between clinicopathologic variables and FS positivity were analyzed using Fisher’s exact test. Diagnostic performance of cortical thickness was calculated.
Results: Sentinel lymph node metastasis was detected in 3 patients (11.5%). Loss of fatty hilum on AUS was significantly associated with FS positivity (p = 0.009), whereas cortical thickness alone was not. Cortical thickness ≥0.3 cm showed 66.7% sensitivity, 69.6% specificity, 22.2% positive predictive value, and 94.1% negative predictive value. Most tumors were invasive ductal carcinoma and hormone receptor positive.
Conclusion: Preoperative axillary ultrasound of nodal morphology may help identify early breast cancer patients at minimal risk of sentinel lymph node metastasis. A cortical thickness <0.3 cm demonstrated a high negative predictive value in this pilot study. These findings suggest that selective omission of intraoperative frozen section may be feasible in carefully selected patients; however, larger studies are required to confirm these observations