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Lymph Node Staging with US (and FNA)

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Lobar Approach to Breast Ultrasound

Abstract

Preoperative knowledge of regional lymph node status (N staging) is essential before planning a treatment for breast cancer. US is able to detect metastases smaller than 5 mm and to guide sampling, including for the internal mammary chain, without risk.

There is new evidence that in the absence of metastatic disease on US examination and US-guided fine-needle aspiration cytology (FNAC), axillary sentinel lymph node (surgical) biopsy (SLNB) and even axillary lymph node dissection (ALND) would be unnecessary because both are rarely positive for heavy metastatic burden, and therefore treatment options will not change.

Promoting this way of workup for patients with breast cancer would be beneficial for the patients, as compared to other imaging techniques and surgical procedures, in terms of irradiation, time to diagnosis, and treatment. Last but not least, the cheap US-guided FNAC is cost-effective, both for developing countries having restricted access to high-level technologies, such as MRI, PET/CT, and SLNB, and in First World countries which are faced with a permanent increase in health expenditure.

This chapter offers a current review of the methods for nodal staging assessment in breast cancer patients and underlines new frontiers for evaluation of small superficial lymph nodes with ultrasound such as the “avascularity” of a micrometastasis in the nodal cortex. The impact of intramammary nodes and internal (parasternal) mammary nodes are particularly discussed.

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Abbreviations

ALND:

Axillary lymph node (surgical) dissection

AUS:

Axillary ultrasound

FNA:

Fine-Needle Aspiration

LN:

Lymph node

SN:

Sentinel node

NPV:

Negative predictive value

PPV:

Positive predictive value

SLNB:

Sentinel lymph node (surgical) biopsy

US:

Ultrasound

US-FNAB:

US-guided fine-needle aspiration biopsy (with core biopsy needle)

US-FNAC:

US-guided fine-needle aspiration cytology

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Fournier, D. (2018). Lymph Node Staging with US (and FNA). In: Amy, D. (eds) Lobar Approach to Breast Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-61681-0_10

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  • Print ISBN: 978-3-319-61680-3

  • Online ISBN: 978-3-319-61681-0

  • eBook Packages: MedicineMedicine (R0)

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