Axillary tumour burden in women with a fine-needle aspiration/core biopsy-proven positive node on ultrasonography compared to women with a positive sentinel node

Abstract

Patients with AUS-detected metastases had a higher axillary tumour burden than those with SNB-detected metastases. Around 40 per cent of patients with AUS-detected nodal disease had one or two nodes with macrometastases and were thus overtreated by ALND.

Axillary Nodal Burden in Breast Cancer Patients With Pre-operative Fine Needle Aspiration-proven Positive Lymph Nodes Compared to Those With Positive Sentinel Nodes

“…This last finding could be related to the more aggressive tumor characteristics highlighted in the USNB-positive patients. In accordance with what has been reported in other studies (20,24,26), in the present study this cohort of patients had more aggressive tumor characteristics as well. Larger tumor size, estrogens receptor negativity, HER-2 amplification, high Ki-67 proliferation index, high histological grade and extranodal invasion were significantly higher when compared to the SLNB-positive group.…”

“…In addition, in this category of patients, Verheuvel et al (20) have found a more intense extranodal invasion and worse disease-free survival rates compared to those with positive SLNB. However, other studies (25)(26)(27) have found that about half of positive USNB patients could be treated safely with axillary preservation according to the Z0011 trial criteria.…”

“…This study showed that a larger tumor size and a higher Ki-67 proliferation index could potentially be used as predictive factors of a high nodal burden. Lloyd et al (26) have reported that the combination between tumor size and tumor histology have a high sensitivity (89%) and a high positive predictive value (63%) to forecast a higher nodal burden in USNBpositive patients. Similarly, Pilewskie et al (25) have reported that tumor histology and lympho-vascular invasion were statistically significant predictive factors of an extensive nodal involvement.…”

Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis

“…The most recent review examining the role of image‐guided percutaneous biopsy in axillary lymphadenopathy noted that 56 per cent of patients have positive axillary imaging. This indicates that such preoperative investigation provides valuable information to guide treatment planning for these patients in the context of tailored axillary management strategies.…”

“…This indicates that such preoperative investigation provides valuable information to guide treatment planning for these patients in the context of tailored axillary management strategies. Furthermore, it has been reported that in patients with positive axillary lymph nodes detected by ultrasonography, factors such as tumour size (less than 20 mm) or histology (invasive ductal or lobular) could identify the subset of patients likely to have a lower burden of axillary disease (2 or fewer macrometastases), who could potentially be selected for SNB instead of ALND. There is thus an argument to support the continued use of axillary ultrasonography in the preoperative investigation of patients with early breast cancer without committing all patients with node‐positive disease to ALND.…”