Preoperative axillary imaging with percutaneous lymph node biopsy is valuable in the contemporary management of patients with breast cancer

Hieken, Tina J.; Trull, Brent C.; Boughey, Judy C.; Jones, Katie N.; Reynolds, Carol; Shah, Sejal; Glazebrook, Katrina N.

doi:10.1016/j.surg.2013.07.017

Cited by 92 publications

(96 citation statements)

References 25 publications

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“…Positive nodal disease on imaging was also associated with an increased nodal tumor burden [19]. As an example, one abnormal lymph node detected on ultrasound may correspond to multiple (three to five or more) metastatic nodes found on final pathologic analysis [20, 21]. This indicates that ultrasound potentially identifies patients with a higher burden of disease in the nodes.…”

Section: Discussionmentioning

confidence: 99%

Axillary Ultrasound Identifies Residual Nodal Disease After Chemotherapy: Results From the American College of Surgeons Oncology Group Z1071 Trial (Alliance)

Le-Petross

McCall

Hunt

et al. 2018

American Journal of Roentgenology

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OBJECTIVE The purpose of this study is to determine lymph node features on axillary ultrasound (US) images obtained after neoadjuvant chemotherapy that are associated with residual nodal disease in patients with initial biopsy-proven node-positive breast cancer. SUBJECTS AND METHODS All patients had axillary US performed after neoadjuvant chemotherapy. Axillary US images were centrally reviewed for lymph node size, cortical thickness, and cortical morphologic findings (type I indicated no visible cortex; type II, a hypoechoic cortex ≤ 3 mm; type III, a hypoechoic cortex > 3 mm; type IV, a generalized lobulated hypoechoic cortex; type V, focal hypoechoic cortical lobulation; and type VI, a totally hypoechoic node with no hilum). Lymph node characteristics were compared with final surgical pathologic findings. RESULTS Axillary US images obtained after neoadjuvant chemotherapy and surgical pathologic findings were available for 611 patients. Residual nodal disease was present in 373 patients (61.0%), and 238 (39.0%) had a complete nodal pathologic response. Increased cortical thickness (mean, 3.5 mm for node-positive disease vs 2.5 mm for node-negative disease) was associated with residual nodal disease. Lymph node short-axis and long-axis diameters were significantly associated with pathologic findings. Patients with nodal morphologic type I or II had the lowest rate of residual nodal disease (51 of 91 patients [56.0%] and 138 of 246 patients (56.1%), respectively), whereas those with nodal morphologic type VI had the highest rate (44 of 55 patients [80.0%]) (p = 0.004). The presence of fatty hilum was significantly associated with node-negative disease (p = 0.0013). CONCLUSION Axillary US performed after neoadjuvant chemotherapy is useful for nodal response assessment, with longer short-axis diameter, longer long-axis diameter, increased cortical thickness, and absence of fatty hilum significantly associated with residual nodal disease after neoadjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Axillary Ultrasound Identifies Residual Nodal Disease After Chemotherapy: Results From the American College of Surgeons Oncology Group Z1071 Trial (Alliance)

Le-Petross

McCall

Hunt

et al. 2018

American Journal of Roentgenology

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“…We perform preoperative axillary ultrasound routinely to guide the management of patients with invasive breast cancer. [25][26][27] Eligibility was maintained if intraoperative frozen section pathology examination confirmed negative breast tumor margins and, for patients with invasive cancer, negative SLNs. The cavity was measured to determine appropriate catheter size.…”

Section: Patientsmentioning

confidence: 99%

A Novel Treatment Schedule for Rapid Completion of Surgery and Radiation in Early-Stage Breast Cancer

et al. 2016

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“…Axillary lymph node FNA and the AUS finding of solitary versus multiple abnormal nodes allowed us to identify a small group (\10 %) of T1 and T2 patients with a high likelihood of C3 metastatic nodes, extranodal extension, and/or pathologic N2 or N3 disease who fell outside the population enrolled in Z0011. 9 In our study, 22 % of patients with a negative AUS were SLN positive at operation, but only 4 % had 3 or more positive nodes at operation. These data may prove helpful in further refining indications for ALND in the presence of a positive sentinel node.…”

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confidence: 41%

Preoperative axillary imaging with percutaneous lymph node biopsy is valuable in the contemporary management of patients with breast cancer

Cited by 92 publications

References 25 publications

Axillary Ultrasound Identifies Residual Nodal Disease After Chemotherapy: Results From the American College of Surgeons Oncology Group Z1071 Trial (Alliance)

Axillary Ultrasound Identifies Residual Nodal Disease After Chemotherapy: Results From the American College of Surgeons Oncology Group Z1071 Trial (Alliance)

A Novel Treatment Schedule for Rapid Completion of Surgery and Radiation in Early-Stage Breast Cancer

The Promise of Axillary Imaging in Individualized Surgical Management of Breast Cancer Patients: Another Step Forward

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