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Annals of Surgical Oncology

, Volume 22, Issue 13, pp 4241–4246 | Cite as

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

  • Donna PlechaEmail author
  • Shiyu Bai
  • Helen Patterson
  • Cheryl Thompson
  • Robert Shenk
Breast Oncology

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.

Keywords

Sentinel Node Sentinel Node Lymph Node Biopsy Positive Node Axillary Lymph Node Dissection Axillary Dissection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

There are no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Donna Plecha
    • 1
    Email author
  • Shiyu Bai
    • 2
  • Helen Patterson
    • 3
  • Cheryl Thompson
    • 4
  • Robert Shenk
    • 5
  1. 1.Department of RadiologyUniversity Hospitals Case Medical CenterClevelandUSA
  2. 2.Case Western University School of MedicineClevelandUSA
  3. 3.Amherst CollegeAmherstUSA
  4. 4.Case Western Reserve UniversityClevelandUSA
  5. 5.Department of SurgeryUniversity Hospitals Case Medical CenterClevelandUSA

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