Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy

Rattay, Tim; Muttalib, Masoom; Khalifa, Eiman; Duncan, Alison; Parker, Shannon

doi:10.1016/j.breast.2011.09.014

Cited by 23 publications

(21 citation statements)

References 35 publications

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“…While some suggest that axillary US and needle biopsy are essential in the preoperative work-up of breast cancer patients to help dictate surgical management 9-11 , the role of preoperative axillary staging is shifting in the ACOSOG Z0011 era. Houssami et al assessed the utility of preoperative axillary US and needle biopsy in discriminating low versus high nodal disease burden based on needle biopsy results in an analysis of 7 studies and report results similar to our findings.…”

Section: Discussionmentioning

confidence: 99%

Does a Positive Axillary Lymph Node Needle Biopsy Result Predict the Need for an Axillary Lymph Node Dissection in Clinically Node-Negative Breast Cancer Patients in the ACOSOG Z0011 Era?

et al. 2015

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Background ACOSOG Z0011 defined clinical node negativity by physical exam alone. Although axillary US with biopsy has a positive predictive value for lymph node (LN) metastases approaching 100%, it may not appropriately identify clinically node-negative women with ≥3 positive LNs (+LNs) who require ALND. We sought to identify the total number of +LNs in women presenting with cT1-2N0 breast carcinoma with a positive preoperative LN biopsy to evaluate the potential for overtreatment when ALND is performed on the basis of a positive needle biopsy in patients who otherwise meet ACOSOG Z0011 eligibility criteria. Methods Patients with cT1-2N0 breast cancer by physical exam with a positive preoperative LN biopsy were identified from a prospective institutional database. Clinicopathologic characteristics and axillary imaging results were compared between women with 1-2 total +LNs and ≥3 total +LNs. Results Between 5/2006-12/2013, 141 women with cT1-2N0 breast cancer had abnormal axillary imaging and a preoperative +LN biopsy (median patient age: 51yrs, median tumor size:2.4cm,86% ductal histology,79% ER+). 66 (47%) women had 1-2 total +LNs, 75 (53%) had ≥3 total +LNs. Women with ≥3 total +LNs had larger tumors (2.4 vs 2.2cm, p=0.03), fewer tumors with ductal histology (79% vs 94%, p=0.01), more lymphovascular invasion (80% vs 61%,p=0.01) and higher median BMI (29.2 vs 27.1,p=0.04). Having >1 abnormal LN on axillary imaging was significantly associated with having ≥3 total +LNs on final pathology (68% vs 43% p=0.003). Conclusions Axillary imaging with preoperative LN biopsy does not accurately discriminate low-versus high-volume nodal disease in clinically node-negative patients.

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Section: Discussionmentioning

confidence: 99%

Does a Positive Axillary Lymph Node Needle Biopsy Result Predict the Need for an Axillary Lymph Node Dissection in Clinically Node-Negative Breast Cancer Patients in the ACOSOG Z0011 Era?

et al. 2015

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“…A number of prospective studies looking at the role of ultrasound-guided sampling of axillary lymph nodes in breast cancer have been published [8,16-18]. Reported sensitivities and specificities in the literature were 40% to 87%, and 56% to 100%, respectively [16].…”

Section: Discussionmentioning

confidence: 99%

Sparing sentinel node biopsy through axillary lymph node fine needle aspiration in primary breast cancers

2013

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BackgroundAxillary lymph node status is an important staging and prognostic factor in breast cancer. This study aimed to evaluate the efficacy of axilla fine needle aspiration cytology (FNAC) in primary breast cancer without a palpable node and even without image characteristics of a metastatic node.MethodsFrom June 2008 to January 2012, 77 patients met the inclusion criteria of having received a FNAC procedure during the diagnostic protocol of primary breast cancer with the characteristic of impalpable axilla nodes, and of having received axillary surgery after that, according to the guidelines. The patients’ characteristics, clinical-pathological features, pre-operative axillary lymph node FNAC findings, surgical lymph node report, and definite pathologic staging were reviewed.ResultsThe FNAC procedures had a reported sensitivity of 58.82%, specificity of 100%, positive predictive value of 100%, negative predictive value of 72.55%, and accuracy of 80.28%. There were no false positives on FNAC; therefore, the positive likelihood ratio approached infinity. The negative likelihood ratio was 41.18%. Axillary lymph node FNAC is feasible in newly diagnosed breast cancer patients to evaluate metastatic lymph nodes even in those without clinical or ultrasonic evidence of lymphadenopathy.ConclusionsFNAC can be a routine evaluation for most primary breast cancer patients with benefits in expediting treatment. For those patients with positive findings of the axilla, sentinel node biopsy can be avoided.

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“…A negative nodal status on AxUS with sampling (AxUS+ S) does not definitively exclude axillary nodal metastases and these patients must proceed to SLNB to confirm nodal staging [10]. However, the consistently high specificity, positive predictive value (PPV) [7] and convenience of performing AxUS+S during assessment of the primary tumour makes it an excellent pre-operative staging technique.…”

Section: Introductionmentioning

confidence: 99%

The Z0011 Trial: Is this the end of axillary ultrasound in the pre-operative assessment of breast cancer patients?

et al. 2015

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Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy

Cited by 23 publications

References 35 publications

Does a Positive Axillary Lymph Node Needle Biopsy Result Predict the Need for an Axillary Lymph Node Dissection in Clinically Node-Negative Breast Cancer Patients in the ACOSOG Z0011 Era?

Does a Positive Axillary Lymph Node Needle Biopsy Result Predict the Need for an Axillary Lymph Node Dissection in Clinically Node-Negative Breast Cancer Patients in the ACOSOG Z0011 Era?

Sparing sentinel node biopsy through axillary lymph node fine needle aspiration in primary breast cancers

The Z0011 Trial: Is this the end of axillary ultrasound in the pre-operative assessment of breast cancer patients?

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