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Consequences of Axillary Ultrasound in Patients with T2 or Greater Invasive Breast Cancers

  • Original Article – Breast Oncology
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background. Axillary ultrasound (AUS) with needle biopsy is used to detect metastasis in patients with invasive breast cancers. Our hypothesis is that preoperative AUS significantly reduces sentinel node biopsy (SLNB) use in patients with invasive breast tumors >2 cm upon clinical examination.

Methods. A single-institution database of patients with breast cancer and AUS was reviewed. Patients with incomplete records, clinical tumor <2 cm, or postoperative AUS were excluded. A control cohort of non-AUS patients with clinical T2 (cT2) or greater disease was identified. Clinicopathologic data were collected. Simple Kappa coefficient and chi-square statistical analyses were performed.

Results. AUS was performed in 153 patients vs. 370 controls. Of AUS patients, 112 (73.2%) had cT2 disease vs. 272 (73.5%) controls. Median AUS patient age was 53.7 (range, 22.8–85.8) years vs. 53.8 (range, 26.7–91.6) years; median pathologic tumor was 3.8 (range, 1.0–20.0) cm in AUS patients vs. 2.5 (range, 0.1–11.0) cm. Among AUS patients, 78% had needle biopsy; 85 of 120 (70.8%) were positive. Sixty-eight patients had SLNB: 33 after negative AUS and 35 after negative needle biopsy. Twenty-three SLNB (37.3%) were positive; 15 of 33 after negative AUS and 8 of 35 after a negative needle biopsy. Axillary dissection was performed in 102 of 153 vs. 225 of 370 controls. Sensitivity and specificity of AUS was 86.2% and 40.5%. Sensitivity of AUS plus needle biopsy was 89.3% with 100% specificity. Neoadjuvant chemotherapy was given to 49.7% of AUS patients. AUS reduced costs by more than $4,000 per patient.

Conclusions. AUS reduces SLNB use and affects treatment in patients with cT2 or greater breast cancer. Routine AUS should be considered in this population.

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References

  1. Tate J, Lewis V, Archer T, et al. Ultrasound detection of axillary lymph node metastases in breast cancer. Eur J Surg Oncol. 1989;15(2):139–41.

    PubMed  CAS  Google Scholar 

  2. Mustonen P, Farin P, Kosunen O. Ultrasonographic detection of metastatic axillary lymph nodes in breast cancer. Ann Chir Gynaecol. 1990;79(1):15–8.

    PubMed  CAS  Google Scholar 

  3. de Kanter A, van Eijck C, van Geel A, et al. Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg. 1999;86(11):1459–62.

    Article  PubMed  Google Scholar 

  4. Ciatto S, Brancato B, Risso G, et al. Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging. Breast Cancer Res Treat. 2007;103(1):85–91.

    Article  PubMed  Google Scholar 

  5. Genta F, Zanon E, Camanni M, et al. Cost/accuracy ratio analysis in breast cancer patients undergoing ultrasound-guided fine-needle aspiration cytology, sentinel node biopsy, and frozen section of node. World J Surg. 2007;31(6):1157–65.

    Article  Google Scholar 

  6. Krishnamurthy S, Sneige N, Bedi D, et al. Role of ultrasoundguided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. 2002;95(5):982–8.

    Article  PubMed  Google Scholar 

  7. Walsh J, Dixon J, Chetty U, Paterson D. Colour Doppler studies of axillary node metastases in breast carcinoma. Clin Radiol. 1994;49(3):189–91.

    Article  PubMed  CAS  Google Scholar 

  8. Bonnema J, van Geel AN, van Ooijen B, et al. Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg. 1997;21(3):270–4.

    Article  PubMed  CAS  Google Scholar 

  9. Garcia-Ortega MJ, Benito MA, Vahamonde EF, et al. Pretreatment axillary ultrasonography and core biopsy in patients with suspected breast cancer: Diagnostic accuracy and impact on management. Eur J Radiol. 2010 Epub].

  10. Bedi D, Krishnamurthy R, Krishnamurthy S, et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. Am J Radiol. 2008;191:646–52.

    Google Scholar 

  11. Vassallo P, Wernrcke K, Roos N. Differentiation of benign from malignant superficial lymphadenopathy: the role of high resolution US. Radiology. 1992;183:215–22.

    PubMed  CAS  Google Scholar 

  12. Raza S. Axillary adenopathy. In: Berg W, editor. Diagnostic imaging: breast, vol. IV. Salt Lake City: Amirsys; 2008. p. 30–1.

  13. Kilbride K, Lee M, Nees A, et al. Axillary staging prior to neoadjuvant chemotherapy for breast cancer: predictors of recurrence. Ann Surg Oncol. 2008;15(11):3252–8.

    Article  PubMed  Google Scholar 

  14. Batsis C, Ziogas D, Fatouros M. Neoadjuvant chemotherapy for breast cancer: does pretreatment axillary nodal staging improve decision making? Ann Surg Oncol. 2009;16(4):1063–4.

    Article  PubMed  Google Scholar 

  15. Buchholz TA, Lehman CD, Harris JR, et al. Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute Conference. J Clin Oncol. 2008;26(5):791–7.

    Article  PubMed  Google Scholar 

  16. Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol. 2000;18(20):3480–6.

    PubMed  CAS  Google Scholar 

  17. Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2005;23(12):2694–702.

    Article  PubMed  Google Scholar 

  18. Newman E, Sabel M, Nees A, et al. Sentinel lymph node biopsy performed after neoadjuvant chemotherapy is accurate in patients with documented node-positive breast cancer at presentation. Ann Surg Oncol. 2007;14(10):2946–52.

    Article  PubMed  Google Scholar 

  19. Brancato B, Zappa M, Bricolo D, et al. Role of ultrasound-guided fine needle cytology of axillary lymph nodes in breast carcinoma staging. Radiol Med. 2004;108(4):345–55.

    PubMed  Google Scholar 

  20. Davis J, Brill Y, Simmons S, et al. Ultrasound-guided fine-needle aspiration of clinically negative lymph nodes versus sentinel node mapping in patients at high risk for axillary metastasis. Ann Surg Oncol. 2006;13(12):1545–52.

    Article  PubMed  Google Scholar 

  21. Hinson J, McGrath P, Moore A, et al. The critical role of axillary ultrasound and aspiration biopsy in the management of breast cancer patients with clinically negative axilla. Ann Surg Oncol. 2008;15(1):250–5.

    Article  PubMed  CAS  Google Scholar 

  22. Sapino A, Cassoni P, Zanon E, et al. Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer. 2003;88(5):702–6.

    Article  PubMed  CAS  Google Scholar 

  23. Tahir M, Osman K, Shabbir J, et al. Preoperative axillary staging in breast cancer-saving time and resources. Breast J. 2008;14(4):369–71.

    Article  PubMed  Google Scholar 

  24. van Rijk M, Deurloo E, Nieweg O, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 2006;13(1):31–5.

    Article  PubMed  Google Scholar 

  25. McGuire K, Santillan A, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009;16(10):2682–90.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Comprehensive Breast Program, Moffitt Cancer Center, Tampa, FL, USA

    M. Catherine Lee, John V. Kiluk, Nazanin Khakpour, Charles E. Cox, W. Bradford Carter & Christine Laronga

  2. University of South Florida College of Medicine, Tampa, FL, USA

    Jennifer Eatrides

  3. Division of Breast Imaging, Moffitt Cancer Center, Tampa, FL, USA

    Alec Chau

  4. Biostatistics Core, Moffitt Cancer Center, Tampa, FL, USA

    Gang Han

Authors
  1. M. Catherine Lee
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  2. Jennifer Eatrides
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  3. Alec Chau
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  4. Gang Han
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  5. John V. Kiluk
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  6. Nazanin Khakpour
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  7. Charles E. Cox
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  8. W. Bradford Carter
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  9. Christine Laronga
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Correspondence to M. Catherine Lee.

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Lee, M.C., Eatrides, J., Chau, A. et al. Consequences of Axillary Ultrasound in Patients with T2 or Greater Invasive Breast Cancers. Indian J Surg Oncol 2, 159–164 (2011). https://doi.org/10.1007/s13193-011-0085-3

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  • DOI: https://doi.org/10.1007/s13193-011-0085-3

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