The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

Abstract

Rationale and Objective Evaluation of nodal involvement in early-stage breast cancers (T1 or T2) changed following the Z11 trial; however, not all patients meet the Z11 inclusion criteria. Hence, the relevance of ultrasound imaging of the axilla and fine-needle aspiration biopsy (FNA) in early-stage breast cancers was investigated. Materials and Methods In this single-center, retrospective study, 758 subjects had pathology-verified breast cancer diagnosis over a 3-year period, of which 128 subjects with T1/T2 breast tumors had abnormal axillary lymph nodes on ultrasound, had FNA, and proceeded to axillary surgery. Ultrasound images were reviewed and analyzed using multivariable logistic regression to identify the features predictive of positive FNA. Accuracy of FNA was quantified as the area under the receiver operating characteristic curve with axillary surgery as reference standard. Results Of 128 subjects, 61 and 65 were positive on FNA and axillary surgery, respectively. Sensitivity, specificity, positive- and negative-predictive values of FNA were 52/65 (80%), 54/63 (85.7%), 52/61(85.2%) and 54/67 (80.5%), respectively. After adjusting for neoadjuvant chemotherapy between FNA and surgery, a positive FNA was associated with higher likelihood for positive axillary surgery (odds ratio: 22.7; 95% CI: 7.2–71.3, p<0.0001), and the accuracy of FNA was 0.801 (95% CI: 0.727–0.876). Among ultrasound imaging features, cortical thickness and abnormal hilum were predictive (p<0.017) of positive FNA with accuracy of 0.817 (95% CI: 0.741–0.893). Conclusion Ultrasound imaging and FNA can play an important role in the management of early breast cancers even in the post-Z11 era. Higher weightage can be accorded to cortical thickness and hilum during ultrasound evaluation.

Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology

“…Ultrasound is widely available, inexpensive, and is valuable diagnostic tool as an adjunct to mammography 3 . Some of the most common uses of ultrasound are to distinguish solid from cystic lesions, to evaluate palpable masses not visible in mammography, to evaluate young pregnant patients with palpable masses, and to characterize lymph nodes 5–7 . The lack of radiation and real-time nature of the ultrasound makes it the method of choice for image-guided procedures 3,6 .…”

Ultrasound guided needle biopsy of axilla to evaluate nodal metastasis after preoperative systemic therapy in cohort of 106 breast cancers enriched with BRCA1/2 pathogenic variant carriers

“…There are data on effectiveness of axillary ultrasound and FNAC to evaluate nodal status prior breast cancer treatment as well evaluation of ultrasound method alone after PST [ 14 , 15 ]. However to the best of our knowledge there are only two small series (including our earlier one), which are reporting on axillary lymph node FNAC accuracy after PST [ 11 , 12 ].…”

Role of Percutaneous Needle Biopsy of Axillary Lymph Nodes to Evaluate Node Positive Breast Cancer after Neoadjuvant Chemotherapy

“…There are data on effectiveness of axillary ultrasound and FNAC to evaluate nodal status prior to breast cancer treatment, and use of the ultrasound method alone after NAC has been evaluated (Pesek et al, 2017;Vijayaraghavan, 2017). However, to the best of our knowledge there are no data available on accuracy of axillary lymphnode FNAC and/or core needle biopsy (CNB) after NAC.…”