Value of Preoperative Ultrasound-Guided Axillary Lymph Node Biopsy for Preventing Completion Axillary Lymph Node Dissection in Breast Cancer: A Systematic Review and Meta-Analysis

Diepstraten, S.C.E.; Sever, Ali; Buckens, Constantinus F.; Veldhuis, Wouter B.; Dalen, Thijs van; Bosch, Maurice A.A.J. van den; Mali, Willem P.Th.M.; Verkooijen, Helena M.

doi:10.1245/s10434-013-3229-6

Cited by 160 publications

(95 citation statements)

References 47 publications

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“…This finding is limited to the first week after the operation and is no longer present at 6 and 12 months. 18 The routine assessment of the axilla by means of ultrasound, combined with fine-needle biopsy, has reduced the rate of positive SLNBs 19,20 and has enabled the identification of patients with axillary metastases who require ALND. A retrospective study of 1140 patients (T1/T2) at the Mayo Clinic in Rochester, Minnesota (all of whom were negative for axillary ultrasound and fine-needle aspiration), reported 13% of patients to be SLNB positive.…”

Section: Discussionmentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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We performed a retrospective analysis of 1156 patients affected by early breast cancer in order to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. Background: The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB. Patients and Methods: We performed a retrospective analysis of 1156 patients with early breast cancer to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes. Results: Of the 1156 cases, only 106 (9.2%) had > 2 axillary metastatic lymph nodes. More specifically, 38 (4.3%) of 884 T1 cases, and 6 (2.3%) of 257 of T1b cases had > 2 metastatic lymph nodes. Conclusion: The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. The ongoing studies on avoiding SLNB will likely prove the noninferiority of omitting biopsy because these studies are conducted in the whole population of early breast cancers. It is necessary to identify more accurately the subpopulation of patients who may benefit from axillary surgery.

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Section: Discussionmentioning

confidence: 99%

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Marrazzo

Damiano

Taörmina³

et al. 2017

Clinical Breast Cancer

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“…4 Breast magnetic resonance imaging (MRI) is now widely used to evaluate accurate tumour extent. Breast MRI that includes the axillary region may provide radiologists with the chance to re-evaluate ALNs.…”

Section: Introductionmentioning

confidence: 99%

Adding MRI to ultrasound and ultrasound-guided fine-needle aspiration reduces the false-negative rate of axillary lymph node metastasis diagnosis in breast cancer patients

et al. 2015

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“…Although 20% of the patients in this study with normal lymph nodes before NAC ultimately had nodal metastases, this is consistent with the described FNR (up to 25%) of AUS in the literature. 13 This FNR should not have changed the treatment strategies for the patients in this study. Current data from the same institution suggests a 21 to 97% pathologic complete response (pCR) rate after NAC depending on tumor biology.…”

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confidence: 95%

Axillary Ultrasound Before Neoadjuvant Chemotherapy for Breast Cancer: Don’t Discount the Benefits Yet!

Schwartz

Margenthaler²

2017

Ann Surg Oncol

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Axillary lymph node status remains a top prognostic indicator for patients with breast cancer. It has been well established that the extent of nodal involvement plays a key role in the risk for both local recurrence and overall survival, and nodal staging has a tremendous impact on systemic therapy and radiotherapy treatment recommendations.During the last 25 years, significant changes in our nodal assessment techniques have occurred, with a trend toward less invasive and less extensive dissections. After NSABP B-32, sentinel lymph node biopsy (SLNB) alone became the standard of care for nodal staging of clinically node-negative (cN0) patients.1 Then, ACOSOG Z0011 illustrated the safety of SLNB alone in conjunction with adjuvant whole-breast radiation for women with T1 or T2 tumors undergoing lumpectomy with two or fewer positive sentinel lymph nodes (SLN), thereby avoiding axillary lymph node dissection (ALND) for 84% of SLNB-positive patients.2 However, there continues to be a marked interest in identifying even less invasive, yet oncologically safe, strategies to establish nodal status.The use of axillary ultrasound (AUS) was initially described in 1989 3 and its use has expanded significantly during the last 25 years. The potential benefit of AUS is the ability to triage patients with nodal metastases for upfront ALND, thus avoiding the time and cost of a staged SLNB/ ALND. However, this strategy potentially results in unnecessary ALND for women who would otherwise meet the Z0011 criteria. The role of AUS staging is especially controversial in the setting of patients undergoing neoadjuvant chemotherapy (NAC).In this study by Barrio et al., 4 the ability of pre-NAC AUS to predict nodal metastases after NAC was investigated with 402 cN0 patients receiving NAC between 2008 and 2016. Clinical nodal staging was performed by physical examination and collected by chart review. Of the 162 AUS procedures performed, 131 (81%) showed abnormal lymph nodes. Pathologic staging of these lymph nodes was performed via SLNB before NAC, SLNB alone, SLNB then ALND, or ALND alone. The incidence of positive lymph nodes after NAC was higher, yet not significantly different statistically (p = 0.1), for patients with an abnormal pre-NAC AUS. However, if abnormal axillary lymph nodes were identified on magnetic resonance imaging (MRI) or positron emission tomography (PET) and computed tomography (CT) before NAC, the patients had a significantly greater chance of having histologically positive lymph nodes (pN1) after NAC (p \ 0.001 for both). Differences in tumor biology were found between the patients with pN1 after NAC and the pathologically node-negative (pN0) patients. Nodal disease was more likely to be identified after NAC in the patients with nonductal histology [odds ratio (OR) 2.93; p = 0.003) and in those with estrogen receptor (ER) positivity (OR 3.94; p \ 0.001).The lower rate of response to NAC among patients with invasive lobular cancer and ER ? disease has been illustrated in previous studies. 5,6 In the entire patient ...

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Value of Preoperative Ultrasound-Guided Axillary Lymph Node Biopsy for Preventing Completion Axillary Lymph Node Dissection in Breast Cancer: A Systematic Review and Meta-Analysis

Abstract: Preoperative axillary ultrasound-guided biopsy is a useful step in the process of axillary staging. Approximately 50 % of women with axillary involvement can be identified preoperatively. Still, one in four women with an ultrasound-guided biopsy-"proven" negative axilla has a positive SNB.

Cited by 160 publications

References 47 publications

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

Adding MRI to ultrasound and ultrasound-guided fine-needle aspiration reduces the false-negative rate of axillary lymph node metastasis diagnosis in breast cancer patients

Axillary Ultrasound Before Neoadjuvant Chemotherapy for Breast Cancer: Don’t Discount the Benefits Yet!

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