Does BMI Affect the Accuracy of Preoperative Axillary Ultrasound in Breast Cancer Patients?

Shah, Anushi; Glazebrook, Katrina N.; Boughey, Judy C.; Hoskin, Tanya L.; Shah, Sejal; Bergquist, John R.; Dupont, Sean C.; Hieken, Tina J.

doi:10.1245/s10434-014-3902-4

Cited by 18 publications

(13 citation statements)

References 25 publications

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“…We have previously demonstrated that the identification of abnormal nodes on preoperative imaging 22 or even a positive needle biopsy 23 does not reliably identify a group of patients who require ALND when ACOSOG Z0011 eligibility criteria are otherwise met. While BMI has been not been shown to impact the sensitivity of axillary ultrasound 24-26 , our data suggest that obesity itself is not an indication for additional axillary evaluation.…”

Section: Discussioncontrasting

confidence: 59%

Impact of Body Mass Index on Clinical Axillary Nodal Assessment in Breast Cancer Patients

et al. 2016

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Background Over one-third of American adults are obese, and an elevated body mass index (BMI) has been postulated to reduce the sensitivity of the clinical evaluation of the axilla. Clinical nodal exam is important in allocating breast cancer patients to appropriate axillary management. We sought to determine whether BMI influences the rate of nodal positivity in women designated clinically node negative (cN0) by physical examination. Methods Breast cancer patients deemed cN0 who underwent sentinel lymph node biopsy (SLNB) from 2/2006–12/2011 were identified from a prospectively maintained database. Clinicopathologic features including BMI and axillary surgery results were recorded and compared among pathologically node-negative and node-positive patients. Results Overall, 5142 cN0 patients underwent 5262 SLNB procedures during the study period. Nearly one-third (28%) of patients were obese (BMI>30kg/m2). A positive SLN was identified in 25% of patients; 84% proceeded to axillary lymph node dissection. Predictors of SLN positivity included younger age, larger tumor size, high nuclear grade, multifocality, and lymphovascular invasion. An increased BMI did not correlate with a higher likelihood of SLN positivity (p=0.6). The likelihood of cN0 patients having a high burden of axillary metastases (>3 positive nodes) was 4% overall and, similarly, did not differ according to BMI (p=0.4). Conclusion Elevated BMI was not associated with a higher likelihood of SLN positivity or heavy nodal disease burden among women staged as cN0 by physical exam. These findings indicate that physical examination is appropriate and sufficient for preoperative axillary evaluation in women undergoing initial surgery regardless of patient BMI.

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Section: Discussioncontrasting

confidence: 59%

Impact of Body Mass Index on Clinical Axillary Nodal Assessment in Breast Cancer Patients

et al. 2016

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“…The only patients fast tracked to ANC would be those patients with palpable axillary lymphadenopathy—consistent with the protocols of RCTs of SNB [ 5 – 10 ]. This approach would make a contribution, but may give the appearance of a regressive step and could be detrimental in patients with a high body mass index where axillary ultrasound has been demonstrated to possess great accuracy [ 25 ]. It is known that this approach to omitting pre-operative axillary ultrasound has already been adopted in certain academic breast units within the USA.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of tumour burden in pre-operative axillary ultrasound positive and negative breast cancer patients

Ahmed

Jozsa

Baker

et al. 2017

Breast Cancer Res Treat

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BackgroundManagement of the axilla in breast cancer is becoming increasingly conservative. Patients identified with a low axillary nodal burden (two or fewer involved nodes) at sentinel node biopsy (SNB) can avoid completion axillary node clearance (cANC). ‘Fast track’ to ANC in patients with involved nodes on pre-operative ultrasound may be over-treating a subgroup of these patients with low nodal burden, which would have precluded their need for ANC. This systematic review assesses the proportion of patients with involved nodes on pre-operative axillary ultrasound, which would fit low axillary burden criteria.MethodsMeta-analysis of studies comparing axillary burden of breast cancer patients identified as pre-operative ultrasound negative versus positive was performed. The primary outcome measure was the number of patients with two or fewer involved nodes (macrometastases only). Pooled odds ratio (OR), 95% confidence intervals (CIs), means and probabilities of identifying two or fewer involved nodes versus greater than two were calculated.ResultsSix studies reported the axillary burden in 4271 patients who were either directed straight to ANC or cANC after SNB. There was a significantly greater axillary burden in the ultrasound positive versus negative groups (OR 5.95, 95% CI 5.80–6.11) with mean nodal retrieval values of 2.9 [standard error (SE) 0.2] and 1.6 (SE 0.2) nodes, respectively. Cumulative probabilities identified 78.9% of ultrasound negative and 43.2% of ultrasound positive patients possessed low axillary burden.ConclusionsPre-operative ultrasound positive patients have significantly higher axillary burden. However, nearly half do fit the criteria of low axillary burden and could be considered for omission of ANC.

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“…It has the ability to detect significant nodal disease. We have shown that this does not appear to be influenced by tumor histology nor by patient factors such as body mass index .…”

Section: Imaging Featuresmentioning

confidence: 73%

Axillary Ultrasound in the Management of the Newly Diagnosed Breast Cancer Patient

2015

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Axillary lymph node status remains an important prognostic factor in patients with breast cancer. Axillary ultrasound (AUS) is an important tool in the workup of patients with newly diagnosed breast cancer and also has an emerging role evaluating the axilla after neoadjuvant chemotherapy. This review discusses the value of AUS in the workup and management of patients with newly diagnosed breast cancer and describes its role given the recent changes in axillary management.

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Does BMI Affect the Accuracy of Preoperative Axillary Ultrasound in Breast Cancer Patients?

Cited by 18 publications

References 25 publications

Impact of Body Mass Index on Clinical Axillary Nodal Assessment in Breast Cancer Patients

Impact of Body Mass Index on Clinical Axillary Nodal Assessment in Breast Cancer Patients

Meta-analysis of tumour burden in pre-operative axillary ultrasound positive and negative breast cancer patients

Axillary Ultrasound in the Management of the Newly Diagnosed Breast Cancer Patient

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