Top

Published in:

01-01-2008 | Breast Oncology

The Critical Role of Axillary Ultrasound and Aspiration Biopsy in the Management of Breast Cancer Patients with Clinically Negative Axilla

Authors: J. L. Hinson, MD, P. McGrath, MD, A. Moore, MD, J. T. Davis, Y. M. Brill, MD, E. Samoilova, MD, M. Cibull, MD, M. Hester, MD, E. Romond, MD, K. Weisinger, MD, L. M. Samayoa, MD

Published in: Annals of Surgical Oncology | Issue 1/2008

Abstract

Background

Sonographic evaluation of the axilla can predict node status in a significant proportion of clinically node-negative patients. This review focuses on the value of ultrasound followed by ultrasound-guided cytology in assessing the need for sentinel node mapping and conservative versus complete axillary dissections.

Design

Breast primaries from 168 sentinel node candidates were prospectively assessed for clinicopathologic variables associated with increased incidence of axillary metastases. Patients were classified accordingly, and those at a higher risk underwent ultrasound of their axillae, followed by aspiration biopsy if needed. Sentinel node mapping was performed in all low-risk patients, and in high-risk patients with normal axillary ultrasounds or negative cytology. Final axillary status was compared in terms of nodal stage, number of positive nodes, and size of metastasis.

Results

112 patients were at high risk for nodal disease (67%), with a statistically significant lower probability for remaining node-negative and a statistical significantly higher risk for having more than one positive node. All patients with more than three positive nodes were detected by ultrasound-guided cytology. High-risk patients with final positive axillae missed by ultrasound or ultrasound guided cytology had tumor deposits measuring ≤5 mm.

Conclusion

Extent of axillary dissections can be decided based on the risk for axillary metastases: sentinel node mapping for low-risk patients; less-aggressive axillary dissections for high-risk patients with negative ultrasound and/or negative cytology; and a standard dissection for high-risk patients with positive cytology.

Schulze T, Mucke J, Markwardt J, et al. Long-term morbidity of patients with early breast cancer after sentinel lymph node biopsy compared to axillary lymph node dissection. J Surg Oncol 2006; 93(2):109–19PubMedCrossRef

Burak WE, Hollenbeck ST, Zervos EE, et al. Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer. Curr Surg 2004; 61(3):259–63CrossRef

Kuijt GP, van de Poll-Franse LV, Voogd AC, et al. Survival after negative sentinel lymph node biopsy in breast cancer at least equivalent to after negative extensive axillary dissection. Eur J Surg Oncol 2006; doi:10.1016/j.ejso.2006.11.017

Takei H, Suemasu K, Kurosumi M, et al. Recurrence after sentinel lymph node biopsy with or without axillary lymph node dissection in patients with breast cancer. Breast Cancer 2007; 14(1):16–24PubMedCrossRef

Palesty JA, Foster JM, Hurd TC, et al. Axillary recurrence in women with a negative sentinel lymph node and no axillary dissection in breast cancer. J Surg Oncol 2006; 93(2):129–32PubMedCrossRef

Naik AM, Fey J, Gemignani M, et al. The risk of axillary relapse after sentinel node biopsy for breast cancer is comparable with that of axillary lymph node dissection: a follow-up study of 4008 procedures. Ann Surg 2004; 240(3): 462–8PubMedCrossRef

de Kanter AY, van Eijck CH, van Geel AN, et al. Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg 1999; 86:1459–62PubMedCrossRef

Deurloo EE, Tanis PJ, Gilhuijs KG, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer 2003; 39:1068–73PubMedCrossRef

Temple LK, Baron R, Cody HS 3rd, et al. Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women. Ann Surg Oncol 2002; 9(7):654–62PubMedCrossRef

10.

Davis JT, Brill YM, Simmons S, et al. Ultrasound-guided fine-needle aspiration of clinically negative lymph nodes versus sentinel node mapping in patients at high risk for axillary metastasis. Ann Surg Oncol 2006; 13(12):1545–52PubMedCrossRef

11.

AJCC Cancer Staging Manual, 6th Ed, 2002

12.

Rutledge H, Davis J, Chiu R, et al. Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection. Mod Pathol 2005; 18:762–8PubMedCrossRef

13.

Weiser MR, Montgomery LL, Tan LK, et al. Lymphovascular invasion enhances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodes. Ann Surg Oncol 2001; 8:145–9PubMedCrossRef

14.

Degnim AC, Griffith KA, Sabel MS, et al. Clinicopathologic features of metastasis in non-sentinel lymph nodes of breast carcinoma patients. Cancer 2003; 98:2307–15PubMedCrossRef

15.

Abdessalam SF, Zervos EE, Prasad M, et al. Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer. Am J Surg 2001; 182:316–20PubMedCrossRef

16.

Bedrosian I, Bedi D, Kuerer HM, et al. Impact of clincopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol 2003; 10:1025–30PubMedCrossRef

17.

Elston C. Grading of invasive carcinoma of the breast. (1987) In: Page D, Anderson T, eds. Diagnostic Histopathology of the Breast. New York: Churchill Livingston, pp 300–11

18.

Mansfield L, Sosa I, Dionello R, et al. Current management of the axilla in patients with clinically node-negative breast cancer: A nationwide survey of United Kingdom breast surgeons. Int Semin Surg Oncol 2007; 4:4PubMedCrossRef

19.

Sachdev U, Murphy K, Derzie A, et al. Predictors of non-sentinel lymph node metastasis in breast cancer patients. Am J Surg 2003; 183:213–217CrossRef

20.

Baron RH, Fey JV, Borgen PI, et al. Eighteen sensations after breast cancer surgery: A 5-year comparison of sentinel lymph node biopsy and axillary lymph node dissection. Ann Surg Oncol 2007; 14(5):1653–61PubMedCrossRef

21.

Turner RR, Chu KU, Qi K, et al. Pathologic features associated with nonsentinel lymph node metastases in patients with metastatic breast carcinoma in a sentinel lymph node. Cancer 2000; 89:574–581PubMedCrossRef

22.

Kamath VJ, Giuliano R, Dauway EL, et al. Characteristics of the sentinel lymph node in breast cancer predict further involvement of higher-echelon nodes in the axilla: a study to evaluate the need for complete axillary lymph node dissection. Arch Surg 2001; 136:688–692PubMedCrossRef

23.

Veronesi U, Paganelli G, Luini A, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 2006; 7(12):983–90PubMedCrossRef

24.

Feu J, Tresserra F, Fabregas R, et al. Metastatic breast carcinoma in axillary lymph nodes: In vitro ultrasound detection. Radiology 1997; 205:831–835PubMed

25.

Bonnema J, van Geel AN, van Ooijen B, et al. Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: New diagnostic method. World J Surg 1997; 21:270–274PubMedCrossRef

26.

Yang WT, Metreveli C, Lam PKM, et al. Benign and malignant breast masses and axillary nodes: Evaluation with echo-enhanced color power Doppler ultrasound. Radiology 2001; 220:795–802PubMedCrossRef

27.

Verbanck J, Vandeviele I, De Winter H, et al. Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: A prospective study in 144 consecutive patients. J Clin Ultrasound 1998; 25:53–56CrossRef

Title: The Critical Role of Axillary Ultrasound and Aspiration Biopsy in the Management of Breast Cancer Patients with Clinically Negative Axilla
Authors: J. L. Hinson, MD
P. McGrath, MD
A. Moore, MD
J. T. Davis
Y. M. Brill, MD
E. Samoilova, MD
M. Cibull, MD
M. Hester, MD
E. Romond, MD
K. Weisinger, MD
L. M. Samayoa, MD
Publication date: 01-01-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 1/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9524-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Critical Role of Axillary Ultrasound and Aspiration Biopsy in the Management of Breast Cancer Patients with Clinically Negative Axilla

Abstract

Background

Design

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Design

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2008

Long-Term Results of Liver Resection for Non-colorectal, Non-neuroendocrine Metastases

Status of Sentinel Lymph Node Biopsy in Gynecological Cancers

A Phase II Prospective Multi-institutional Trial of Adjuvant Active Specific Immunotherapy Following Curative Resection of Colorectal Cancer Hepatic Metastases: Cancer and Leukemia Group B Study 89903

Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe?

Variations in Surgical Treatment and Outcomes of Patients With Pancreatic Cancer: A Population-Based Study

Can intra-operative intraperitoneal free cancer cell detection techniques identify patients at higher recurrence risk following curative colorectal cancer resection: a meta-analysis