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Improving the Accuracy of Axillary Lymph Node Surgery in Breast Cancer with Ultrasound-Guided Wire Localization of Biopsy Proven Metastatic Lymph Nodes

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate whether the use of preoperative ultrasound (US)-guided wire localization of metastatic axillary lymph nodes (LN) assessed previously by core needle biopsy (CNB) and clip placement in breast cancer patients improves successful surgical removal.

Methods

A retrospective review examined breast cancer patients who underwent US-guided CNB of an axillary LN and biopsy clip placement as well as axillary lymph node dissection (ALND) or sentinel node lymph node biopsy (SLNB) from 1 January 2010 to 30 September 2013. Preoperative needle localization status, neoadjuvant chemotherapy, and type of axillary LN surgery were reviewed. Confirmation that the metastatic LN had been surgically removed was determined on the specimen image, by pathologic report confirmation, or by pre-radiation therapy computed tomography (CT) scan.

Results

Preoperative US-guided needle localization was performed for 68.2 % (73/107) of the patients, with 97.3 % (n = 71) demonstrating confirmation of biopsy clip and LN removal versus 79.4 % (n = 27) of the 34 patients showing no performance of needle localization (p = 0.0043). Subgroup analysis showed a significant difference in removal of metastatic LN between the patients who received neoadjuvant chemotherapy [97 % of LNs removed with wire localization (n = 65/67) vs. 83.3 % of LNs removed without wire localization (n = 20/24; p = 0.04)] and the patients who had ALND, [96.3 % of LNs removed with wire localization (n = 52/54) vs. 77.8 % of LNs removed without wire localization (n = 21/27; p = 0.015)].

Conclusion

US-guided wire localization of metastatic axillary LNs that have had biopsy with clip placement significantly improves the success rate of surgical removal, allowing more accurate staging and decreasing the false-negative rates of SLNB after neoadjuvant therapy.

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Conflict of interest

There are no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Case Medical Center, Cleveland, USA

    Donna Plecha MD

  2. Case Western University School of Medicine, Cleveland, USA

    Shiyu Bai BS

  3. Amherst College, Amherst, USA

    Helen Patterson

  4. Case Western Reserve University, Cleveland, USA

    Cheryl Thompson PhD

  5. Department of Surgery, University Hospitals Case Medical Center, Cleveland, USA

    Robert Shenk MD

Authors
  1. Donna Plecha MD
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  2. Shiyu Bai BS
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  3. Helen Patterson
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  4. Cheryl Thompson PhD
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  5. Robert Shenk MD
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Corresponding author

Correspondence to Donna Plecha MD.

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Plecha, D., Bai, S., Patterson, H. et al. Improving the Accuracy of Axillary Lymph Node Surgery in Breast Cancer with Ultrasound-Guided Wire Localization of Biopsy Proven Metastatic Lymph Nodes. Ann Surg Oncol 22, 4241–4246 (2015). https://doi.org/10.1245/s10434-015-4527-y

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  • DOI: https://doi.org/10.1245/s10434-015-4527-y

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