1. The critical role of axillary ultrasound and aspiration biopsy in the management of breast cancer patients with clinically negative axilla.
- Author
-
Hinson JL, McGrath P, Moore A, Davis JT, Brill YM, Samoilova E, Cibull M, Hester M, Romond E, Weisinger K, and Samayoa LM
- Subjects
- Axilla diagnostic imaging, Breast Neoplasms diagnostic imaging, Drainage, Female, Humans, Lymph Nodes, Lymphatic Metastasis, Prospective Studies, Risk Factors, Sentinel Lymph Node Biopsy, Ultrasonography, Biopsy, Fine-Needle methods, Breast Neoplasms surgery
- 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.
- Published
- 2008
- Full Text
- View/download PDF