Axillary Lymph Nodes Suspicious for Breast Cancer Metastasis: Sampling with US-guided 14-Gauge Core-Needle Biopsy—Clinical Experience in 100 Patients

Abé, Hiroyuki; Schmidt, Robert A.; Kulkarni, Kirti; Sennett, Charlene A.; Mueller, Jeffrey; Newstead, Gillian M.

doi:10.1148/radiol.2493071483

Cited by 182 publications

(134 citation statements)

References 29 publications

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“…Ultrasound is neither sufficiently sensitive nor specific to be used alone; in patients with indeterminate cortical thickening in the range of 2-4 mm, it is essential to assess whether such patients have involved nodes by FNAC or core biopsy. [20][21][22][23] The majority of surgeons continue to perform ANC which is an appropriate treatment for involved axillary nodes. Axillary radiotherapy is another option for involved nodes, and this is used in some centres and has been shown to produce good long-term disease control rate.…”

Section: Discussionmentioning

confidence: 99%

A further survey of surgical management of the axilla in UK breast cancer patients

Glynn

Williams

Dixon

2010

annals

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Ann R Coll Surg Engl 2010; 92: 506-511 506Breast cancer has the highest incidence of any cancer in the UK with over 45,000 new cases diagnosed each year. 1 Axillary node status is recognised as the single most important prognostic indicator of survival in these patients. Since the advent of effective surgical management of breast cancer by Halsted at the end of the 19th century, 2 and his use of radical mastectomy with axillary lymph node dissection, there has been a continual effort to optimise locoregional surgery, both in terms of morbidity and mortality for breast cancer patients. A key component to this effort has been the development of an appropriate method of assessing the status of the axillary lymph nodes following on from the introduction of four-node sampling (ANS) over 30 years ago. 3,4 The incorporation of sentinel lymph node biopsy (SLNB), originally pioneered in penile cancer in the late 1970s 5 and then adapted for use with melanoma patients, 6 into breast cancer management began in 1993.7 This first report documented the identification of SLNB with radioisotopes; the following year, SLNB localisation using blue dye alone was reported by Giuliano et al. 8 Finally, Albertini et al. 9 introduced the concept of combining radioactive isotope and blue dye ('dual localisation') in 1996. A recent meta-analysis of over 8000 patients concluded that dual localisation is the method for optimising identification of the SLNB; 10 indeed, this is the method being introduced across the UK as part of the NEW START training programme.Surgeons today are faced with a variety of options when considering how best to assess and manage the axilla including: observation only; SLNB with dye only; SLNB with isotope only; SLNB with dual localisation; blind ANS; bluedye-assisted ANS; and/or an axillary lymph node dissection (ALND). Even within these options, there are further decisions to be made, including the optimal site of injection of radioisotope or dye, and which is the best dye or radioisotope to use. Added to this, there are issues in relation to the value of internal mammary node dissection, the role and value of scintigraphy, and pre-operative axillary ultrasound and percutaneous axillary node core biopsy and fine-needle aspiration (FNA). Furthermore, once the status of the axilla is established, there then arises the question of how to man- The aims of this study were to investigate the practice of axillary lymph node management within different units throughout the UK, and to assess changes in practice since our previous survey in 2004. SUBJECTS AND METHODS A structured questionnaire was sent to 350 members of the British Association of Surgical Oncology. RESULTS There were 177 replies from respondents who managed more than 100 patients a year with breast cancer. Of these: 12 did not perform axillary ultrasound at all in their centre; 17 (10%) employed axillary node clearance (ANC) on all patients; 122(69%) performed sentinel node biopsy (SNB) with dual localisation; and 111 respondents had attended the New Sta...

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Section: Discussionmentioning

confidence: 99%

A further survey of surgical management of the axilla in UK breast cancer patients

Glynn

Williams

Dixon

2010

annals

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“…Ultrasound (US) is a simple and well-accepted method to examine axillary and non-axillary lymph nodes associated with breast cancer. Recent publications have reported that routine axillary US combined with cytology or core biopsy is an effective method to evaluate lymph node metastases prior to surgery [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Thus, pretreatment axillary US for early breast cancer patients and needle sampling of morphologically abnormal lymph nodes are now widely recommended [36].…”

Section: Background and Objectivementioning

confidence: 99%

Ultrasound-guided fine needle aspiration cytology in staging clinically node-negative invasive breast cancer

et al. 2011

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The aim of this study was to evaluate the value of ultrasound (US)-guided axillary lymph node fine needle aspiration cytology (FNAC) in staging clinically nodenegative invasive breast cancer. Based on retrospective data, we analyzed sensitivity, specificity, and positive and negative predictive value and efficacy of preoperative axillary US-guided FNAC. A total of 108 consecutive female patients with histological-confirmed invasive breast cancer between January 2006 and December 2010 were included. The management decisions were based on cytological results. Twenty-two patients underwent neoadjuvant chemotherapy and 86 remaining patients benefited of primary surgery. Patients with positive cytology or included in neoadjuvant regimens were scheduled for axillary lymph node dissection (ALND), while patient with negative or nondiagnostic cytology underwent sentinel lymph node biopsy. Axillary US-guided FNAC was compared with definitive pathology of surgically removed lymph nodes. Axillary metastases were found in 55 out of 108 patients (50.9%). In these cases we proceeded with ALND. Excluding the group benefiting from neoadjuvant chemotherapy, we could spare a second surgical intervention for 37 out of 86 patients (43%). The axillary US with FNAC has a sensitivity of 73%, a specificity of 85%, a positive predictive value of 89%, and a negative predictive value of 66%. Without taking into account the neoadjuvant chemotherapy group, in which the statistical analyzes might be biased by the complete histological response, specificity and positive predictive value increased to 100% and negative predictive value to 71%. US combined with FNAC of axillary lymph nodes is a simple, minimally invasive, and reproducible diagnostic approach in improving the preoperative axillary staging of invasive breast cancer patients.Keywords Invasive breast cancer . Axillary node ultrasound . Axillary node cytology . Sentinel lymph node Background and objective

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“…It is moderately sensitive especially when morphological criteria's are used to detect axillary metastasis [8,9]. However, Ax US is subjective and the experience of the Radiologist is important for the diagnostic accuracy.…”

Section: Introductionmentioning

confidence: 99%

Role of Axillary Ultrasound, Fine Needle Aspiration Cytology and Sentinel Lymph Node Biopsy in clinically N0 Breast Cancer

Goel

Janaki

Smitha

et al. 2016

Indian J Surg Oncol

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This study evaluates the combined role of axillary ultrasound, fine needle aspiration cytology and sentinel lymph node biopsy in clinically N0 axilla. Between January 2014 and June 2015, 150 women with early breast cancer underwent axillary ultrasound as a first investigation for nodal status. Suspicious nodes were subjected to image guided fine needle aspiration cytology. Non-suspicious and fine needle aspiration cytology negative axillary nodes proceeded to sentinel lymph node biopsy at time of primary breast surgery. All confirmed positive (cytology and frozen) cases proceeded to axillary lymph node dissection. 52 women had positive axillary nodes at final histology. Axillary ultrasound with fine needle aspiration cytology identified 27 patients with positive axillary nodal status and had a sensitivity of 84.36 % (27/32) and specificity of 87.5 % (14/16). Intraoperative frozen analysis identified a further 13 cases with sensitivity of 56.52 % (13/23) and specificity of 97.56 % (80/82). Overall 76.92 % (40/52) patients with positive axillary metastasis were identified peri-operatively using combination of axillary ultrasound, cytology and sentinel lymph node biopsy.

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Axillary Lymph Nodes Suspicious for Breast Cancer Metastasis: Sampling with US-guided 14-Gauge Core-Needle Biopsy—Clinical Experience in 100 Patients

Abstract: Axillary lymph nodes with abnormal US findings can be sampled with high accuracy and without major complications by using a modified 14-gauge CNB technique.

Cited by 182 publications

References 29 publications

A further survey of surgical management of the axilla in UK breast cancer patients

A further survey of surgical management of the axilla in UK breast cancer patients

Ultrasound-guided fine needle aspiration cytology in staging clinically node-negative invasive breast cancer

Role of Axillary Ultrasound, Fine Needle Aspiration Cytology and Sentinel Lymph Node Biopsy in clinically N0 Breast Cancer

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