Peri-lymph nodal pathological fibrosis and axillary surgical impairment after 14G percutaneous fragment biopsy of sentinel lymph node detected with contrast-enhanced ultrasonography (CEUS) in early breast cancer patients

Abstract

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.

Elaboração e implantação do estudo VENUS

“…Em um estudo realizado no ano anterior, avaliando sobre o uso de ultrassonografia contrastada associada a biópsia por fragmento, foi possível encontrar dados sobre o desempenho do exame de ultrassonografia no serviço. Foi encontrada taxa de falso negativo de 18% da ultrassonografia axilar (63), valor comparável ao encontrado na literatura (60).…”