PresentationRole of ultrasound-guided axillary fine-needle aspiration in the management of invasive breast cancer
Section snippets
Materials and Methods
This retrospective study was reviewed and approved by the Institutional Review Board of Women & Infants’ Hospital. All patients with breast cancer who presented to the Multidisciplinary Tumor Board of the Breast Health Center between January 1998 and June 2005 were reviewed and women undergoing USFNAB for the diagnosis and staging of breast cancer were identified for analysis. Patients with multicentric tumors, inflammatory breast cancer, or without a surgical axillary evaluation were excluded.
Results
We identified 220 patients who underwent USFNAB for breast cancer in the study period. All patients were clinically node negative when they underwent diagnostic ultrasound and if suspicious underwent USFNAB. Of these, 52 were excluded. Of the 168 patients analyzed, 50 (30%) had T1, 87 (51%) had T2, 24 (14%) had T3, and 7 (4%) had T4 cancers. Seventy-nine (47%) had positive and 89 (53%) had negative USFNAB. Of the 168 patients, 107 (63%) had primary surgery and 61 (37%) underwent NACT.
Of the 107
Comments
It has been well established that axillary evaluation is helpful for most management decisions in breast cancer and the initial complete pathologic staging of breast cancer includes the presence or absence of evidence of nodal metastases. In patients with breast cancer with tumor size greater than 1 cm, high-grade tumors, lymphovascular invasion, or casting calcification on mammogram we attempt to establish the presence or absence of metastases to lymph nodes before NACT is started [10], [11],
Conclusions
The high specificity of USFNAB safely can eliminate SLND before initial ALND, particularly in larger lesions. It also permits the best evaluation of the axilla for pathological complete response in NACT patients. For T1 lesions, the specificity is high but the sensitivity is low, suggesting a greater role for sentinel node biopsy examination. In T2 lesions the specificity is high and the sensitivity is moderate and there is less need for sentinel lymph node biopsy examination. The role for
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Evaluation of axillary involvement by ultrasound-guided lymph node biopsy: A prospective study
2015, Gynecologie Obstetrique et FertiliteCitation Excerpt :For CNB, these results are supported by Garcia-Ortega et al., who identified 33% of node-positive patients [20]. For FNAC, the number of SLNB procedures avoided by axillary sampling, redirecting patients to ALND, was estimated in nine studies [17,18,20–26] and was between 8 and 50%. In the meta-analysis by Houssami et al., the median proportion of women triaged directly to ALND was 19.8% for both FNAC and CNB together [27].
Ultrasound-guided lymph node sampling in the initial management of breast cancer
2013, Diagnostic and Interventional ImagingCitation Excerpt :Few studies indicated the micro- or macrometastatic character of the false negatives. There were 10 studies later than the meta-analysis by Alvarez et al. (five retrospective [9,10,23–25] and five prospective [11,15,26–28] studies) published between 2005 and 2010, and for clinical N0 tumours they reported sensitivity of ultrasound-guided fine needle cytology of between 50 and 62% [10,24,25], apart from Baruah et al.’s series [28] in which the sensitivity was low (28%) but concerned two thirds of T1 classified lesions among the 502 patients in the series. One series [9] separated out the results of samples from normal lymph nodes and found sensitivity of 54% [10] with a false negative rate from the ultrasound examination of 13%, this result detected by fine needle cytology of these lymph nodes that exhibited no ultrasound abnormality and were not palpable.
Other Methods of Axillary Assessment and Their Value
2012, Current Problems in CancerShould axillary ultrasound be used in patients with a preoperative diagnosis of ductal carcinoma in situ?
2012, American Journal of SurgerySuspicious axillary lymph nodes in patients with unremarkable imaging of the breast
2010, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :CNB is a safe and minimally invasive technique that can be performed under local anesthesia [2,21]. FNA has been reported as a method with high specificity in most studies, but its sensitivity ranges from 35% to 86% [8,21–24]. In our study only one malignancy (NHL) was diagnosed by FNA, although secondary excision biopsy was needed to obtain more tissue for immunohistochemistry.
Diagnostic Breast Ultrasound: Current Status and Future Directions
2009, Ultrasound ClinicsCitation Excerpt :Furthermore, assessment of all regional nodal basins is not possible with MR imaging, whereas ultrasound allows assessment of multifocality (Fig. 15) and multicentricity (Fig. 16); histologic proof can be obtained inexpensively at the time of the study. In addition, all regional nodal basins can be assessed and biopsied as needed with fine-needle aspiration biopsy.42–45 At the M.D. Anderson cancer center, patients who have been diagnosed as having breast cancer by needle or excisional biopsy undergo an ultrasound of the ipsilateral breast and axillary, internal mammary, and infraclavicular nodal basins.