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In our Trust we classify axillary ultrasound findings as LN1 to LN5, performing fine needle aspiration cytology (FNAC) on LN3 to LN5, where LN3 represents diffuse cortical thickening (DCT) of greater than 2 mm. The resulting FNAC triages patients to either sentinel lymph node biopsy or axillary node dissection. The aim is that patients will undergo only one axillary surgical procedure. There is variation in the literature and between breast units in the DCT threshold for performing FNA, and unnecessary FNAs should be avoided. Does the resulting cytology and surgical histology validate our 2 mm threshold; or can the threshold be safely increased to 2.3 mm or 3 mm as used by some centres?

PB.50: Axillary lymph node ultrasound in breast cancer patients: what minimum threshold for diffuse cortical thickening predicts nodal involvement?