Clinical Assessment of Axillary Lymph Nodes and Tumor Size in Breast Cancer Compared with Histopathological Examination: A Population‐Based Analysis of 2,537 Women

Majid, Shabaz; Tengrup, Ingrid; Manjer, Jonas

doi:10.1007/s00268-012-1788-5

Cited by 30 publications

(22 citation statements)

References 28 publications

(40 reference statements)

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“…Regarding concern with surgical overtreatment, patients with cT 1/2 N0 preoperative staging (fulfilling Z0011 eligibility criteria) but positive AUS‐FNAC/B who were referred directly to ALND (16 patients), 11 patients only had 1 or 2 metastatic LN and no extracapsular extension in the surgical specimen, meaning they might have been spared ALND (11 of 16, 69%). We report lower sensitivity than published in the literature for both PE, ranging between 25% and 35%, and AUS, between 54% and 92% . One possible explanation maybe that our patient population includes mostly early‐stage patients treated by surgery as a first treatment.…”

Section: Patient and Tumor Characteristicscontrasting

confidence: 65%

Preoperative axillary lymph node staging in early breast cancer: Diagnostic efficacy and histopathology correlation

et al. 2019

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Section: Patient and Tumor Characteristicscontrasting

confidence: 65%

Preoperative axillary lymph node staging in early breast cancer: Diagnostic efficacy and histopathology correlation

et al. 2019

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“…8 Patients with palpable adenopathy at presentation are at risk for harboring heavier nodal disease burden, have confirmation of nodal metastasis by needle biopsy, and are managed with either upfront axillary lymph node dissection (ALND) or, increasingly, neoadjuvant chemotherapy. 9 In contrast, cN0 patients comprised the study populations that established the safety of SLNB alone for micro- and macro-metastatic axillary disease 2,5,9-11 , and are frequently spared the morbidity of ALND. 12 Therefore, the accuracy of the surgeons' nodal exam at presentation is paramount in allocating patients to the appropriate axillary treatment.…”

Section: Introductionmentioning

confidence: 99%

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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“…PE alone to determine axillary nodal involvement in breast cancer patients has a poor positive predictive value. The sensitivity and specificity of PE have been shown to be 30% and 93% in one study, and others have demonstrated a false‐positive rate of 53% . The use of AUS with PE has been shown to improve the accuracy of pretreatment nodal evaluation, with the sensitivity and specificity being 59% and 89%, respectively .…”

Section: Discussionmentioning

confidence: 96%

Does use of axillary ultrasound in clinically node‐negative patients receiving neo‐adjuvant systemic therapy for breast cancer lead to surgical overtreatment?

Horwood

Hayek

et al. 2019

Breast J

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Increased use of neo‐adjuvant chemotherapy (NAC) for breast cancer has raised uncertainty regarding staging of the axilla, particularly for patients with a clinically negative axillary physical examination (PE). We sought to determine whether axillary ultrasound (AUS) prior to NAC to identify occult nodal disease is beneficial in patients with a clinically negative examination by evaluating the difference in nodal burden on final pathology in those with abnormal vs normal AUS. A retrospective review of an institutional cancer registry identified patients who underwent NAC for breast cancer and had a pretreatment AUS. Differences in the number of positive lymph nodes (PLN) in patients with a normal axillary PE and abnormal vs normal AUS prior to NAC were determined. A total of 120 patients who received NAC had a negative axillary PE prior to treatment. Fifty‐three had an abnormal AUS and biopsy‐proven lymph node (LN) involvement. In patients with an abnormal AUS, median number of PLNs at surgery was 1 vs 0 for those with a normal AUS (mean difference of 2.12, P < .0001). Of those patients with an abnormal AUS and biopsy‐proven LN involvement, 87% underwent axillary lymph node dissection (ALND) and nearly half had no PLN on final pathology (N = 23, 43%). Patients with a clinically negative axilla and an abnormal AUS were more likely to have PLN at the time of surgery. However, almost half of those patients had no residual LN involvement. Routine AUS prior to NAC may lead to more extensive surgical management of the axilla.

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Clinical Assessment of Axillary Lymph Nodes and Tumor Size in Breast Cancer Compared with Histopathological Examination: A Population‐Based Analysis of 2,537 Women

Abstract: Background

Cited by 30 publications

References 28 publications

Preoperative axillary lymph node staging in early breast cancer: Diagnostic efficacy and histopathology correlation

Preoperative axillary lymph node staging in early breast cancer: Diagnostic efficacy and histopathology correlation

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

Does use of axillary ultrasound in clinically node‐negative patients receiving neo‐adjuvant systemic therapy for breast cancer lead to surgical overtreatment?

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