Scientific paper
Utility of axillary ultrasound examination to select breast cancer patients suited for optimal sentinel node biopsy

https://doi.org/10.1016/j.amjsurg.2003.10.012Get rights and content

Abstract

Background

Because sentinel node (SN) biopsy (SNB) is known to produce false-negative results, we examined the usefulness of axillary ultrasound (AUS) in selecting patients suitable for optimal SNB.

Methods

A positive AUS finding (positive AUS) was defined as an echo pattern of a homogeneously hypoechoic SN without an echo-rich center, indicating massive to extensive nodal involvement. The identification of SNs was performed, and complete axillary dissection was carried out.

Results

A total of 262 women were enrolled into the study (T1 disease = 94; T2 disease = 145; and T3 disease = 23). The incidence of positive AUS increased with increasing size of breast tumor (P <0.0001). The overall identification and false-negative rates were 88.2% and 10.8%, respectively. However, when limited to AUS-negative patients, SNs were identified in 205 of 208 patients (98.6%), and the false-negative rate was 1.7%.

Conclusions

AUS should be included in the preoperative procedure for the selection of breast cancer patients suitable for SNB.

Section snippets

Methods

The data presented here were derived from a study of patients with clinical stage T1 to T3 primary breast carcinoma treated consecutively at the National Defense Medical College Hospital from May 1997 through April 2003. Exclusion criteria for patients were pregnancy, the presence of multiple primary breast tumors, and history of neoadjuvant chemotherapy. Breast cancer diagnosis was made by fine-needle aspiration, core biopsy, or excisional biopsy. All patients were evaluated by clinical

Results

A total of 262 women with breast cancer were enrolled into this study (T1 disease = 94; T2 disease = 145; and T3 disease = 23). Mean age of the entire group was 54.8 years (range 21 to 83). The clinicopathologic features of the primary breast cancers are listed in Table 1.

SNs were identified in 231 of 262 patients (SN detection rate = 88.2%), and false-negative results for metastasis were found in 9 patients. The overall false-negative rate was 10.8% (Table 2). The SN detection rates and the

Comments

SNs represent those most likely to contain metastases. One of the advantages of this procedure is the identification of patients with nodal disease for selective axillary dissection. Because most women with breast cancer do not have axillary metastases, many women can be spared a potentially morbid procedure. However, it is possible that SNs negative for metastasis in a patient who does have metastasis in the axilla will result in a false-negative finding. Cody et al [20] reported that the

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  • Use of axillary ultrasound, ultrasound-fine needle aspiration biopsy and magnetic resonance imaging in the preoperative triage of breast cancer patients considered for sentinel node biopsy

    2011, Ultrasound in Medicine and Biology
    Citation Excerpt :

    Basically, axillary US can be regarded as a highly specific technique, but not very sensitive for the detection of node metastases. According to the literature, in breast cancer patients considered for primary treatment, axillary US examination may offer sensitivity in the range of 56–72% and a specificity in the range of 70–90% (Bruneton et al. 1986; de Freitas et al. 1991; Feu et al. 1997; Sato et al. 2004; Alvarez et al. 2006; Nori et al. 2007; Abe et al. 2009). If FNAB is performed in cases with abnormal US findings, then specificity and PPV reach almost 100% (Bonnema et al. 1997; Ciatto et al. 2007).

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