Power Doppler US is unsuitable for discrimination between local breast cancer recurrence and fibrosis. Although the SWE score and SWE maximum elasticity can make this discrimination, the use of these methods to determine biopsy may lead to poorer clinical outcomes than the current practice of performing biopsies of all suspicious masses.

Objective To evaluate perinodal fibrosis after 14‐gauge staging core‐needle biopsy (CNB) of the axillary sentinel lymph node (SLN) identified using contrast‐enhanced ultrasonography (CEUS) and its interference with subsequent surgical SLN dissection in breast cancer patients. Methods Frequencies or means of main clinical, sonographic, pathological, and surgical characteristics were calculated. We also compared patient groups with and without perinodal pathological fibrosis. Results Forty‐eight patients who underwent CEUS + CNB and axillary surgery were eligible for this cross‐sectional study. Axillary surgical specimens showed perinodal fibrosis in 9/48 (18.7%) patients. Interference with SLN dissection was reported in 4/48 (8.3%) patients (two hematomas, three abnormal palpation findings, and four difficult dissections). The overall surgical detection rate of SLN was 43/48 (89.6%). In the majority of cases, perinodal fibrosis was described as moderate (4/9 [44.4%]) or severe (4/9 [44.4%]). The mean time elapsed between CEUS + CNB and axillary dissection was shorter in patients with perinodal fibrosis (P = .04). Interference with SLN dissection was only reported in patients with perinodal fibrosis (P < .001). Surgical SLN detection was successful in all nine cases in which perinodal pathological fibrosis or interference with SLN dissection was reported. Conclusion Perinodal fibrosis may impair the surgical SLN dissection in early stage breast cancer patients who were staged using CEUS + CNB using a14‐gauge needle.

Objectives: To evaluate peri-lymph nodal pathological fibrosis in axillar surgical specimens of breast cancer patients submitted to 14G percutaneous fragment biopsy (PFB) of axillary sentinel lymph node identified with contrast-enhanced ultrasonography (CEUS). Methods: This study was originally designed to assess the performance of CEUS+PFB on the axillary staging of early-stage breast cancer. The selection of participants was interrupted, and the design was reformulated to this descriptive cross-sectional study after unexpected peri-lymph nodal pathological fibrosis reported in axillary surgery specimens. The frequency or means of the main clinical, ultrasonographic, surgical and pathological characteristics were calculated. T-test or Pearson Chi-Square test compared the groups of patients with and without peri-lymph nodal pathological fibrosis. Results: Forty-eight patients submitted to CEUS+PFB and axillary surgery were eligible for this study. Axillary surgical specimens showed peri-lymph nodal fibrosis in 9/48 (18.7%) patients. The majority of peri-lymph nodal fibrosis were described as moderate (4/9(44.4%)) or severe (4/9 (44.4%)). There was no significant difference between groups regarding patient age (p=0.99), breast tumor size (p=0.60), rate of lymph-node metastasis (p=0.83), use of aromatase inhibitor (p=0.43), number of intradermal contrast injection (p=0.68), CEUS sentinel lymph identification (p=0.10), and CEUS sentinel lymph node mean maximum diameter (p=0.24). Axillary surgical impairment or hematoma were only reported in patients with axillary peri-lymph nodal fibrosis (p<0.001 and p=0.003, respectively). Mean time between CEUS+PFB and axillary surgery was shorter (p=0.04) in patients with peri-lymph nodal fibrosis. Conclusion Peri-lymph nodal pathological fibrosis may impair the axillary surgical procedure of early breast cancer patients staged with CEUS+PFB.