Purpose
IntroductionSentinel lymph node biopsy (SLNB) has replaced axillary dissection for lymph node staging in patients with breast cancer. However, according some series, from 15% to 40% of SLNB have axillary metastases.Determination of nodel invasion is important because if nodel affectation is proved preoperatively (FNA or core needle biopsy), Sentinel Lymph Node Biopsy can be avoided and the surgeon will perform an axillary programed lymphadenectomy.Fine Needle Aspiration (FNA) orCore Needle Biopsy(CNB) can be used to provide histopathologic analisys to the axillary lymph nodes before SLNB. Fine...
Methods and Materials
A retrospective analysis of all axillary preoperative ultrasound performed in patients who had indication of Sentinel Lymph Node Biopsy between August 2008 and December 2009. A total of 190 patientsUltrasound FindingsNormal: if axillary nodes had a thin cortex and a relatively large fatty hiliumAsimetric Cortical Thickening: > 2,5 mm and < 5 mmSuspicious Axillary Lymph Nodes: Cortical thickening > 5mm or without fatty hiliumCore Needle BiopsyWe performed 56 Core Needles Biopsies in patients with Asimetric Cortical Thickening (35 biopsies) and with Suspicious Axillary Lymph Nodes...
Results
Axillary preoperative ultrasound were performed in 190 patients who had indication of Sentinel Lymph Node BiopsyA total of 118 patients had the axillary ultrasound normal. After SLNB 99 were diagnosed accurately (true negative), and the other 19 had metastases (false negative); 12/19 micrometastases (<3mm) and 7/19 macrometastasesOf the 43 asimetric cortical thickening, 29 had metastases proven by axillary lymphadenectomy or ultrasound CNB (true positive). 14/43 had no metastases at surgery (SLNB) (false positive)All of the 29 suspicious axillary lymph nodes were proved by ultrasound CNB...
Conclusion
Axillary Ultrasound has a high Sensibility and Positive Predictive Value in the axillary preoperative study, specially if findings are normal or if there are suspicious lymph nodesUltrasound Core Needle Biopsy is an easy procedure and less operator dependent than FNA. It can be performed the same day and before the Diagnostic Breast Core Needle Biopsy Asymetric Cortical Thickening is related in a high percentage of cases with axillary metastases
References
Hiroyuki Abe, Robert A Schmidt, Charlene A Sennett, Akiko Shimauchi, Gillian M Newestead. "US-guided Core Needle Biopsy of Axillary Lymph Nodes in Patients with Breast Cancer: Why and How to Do It". Radiographics 2007; 27:91-99Podkaraisek M, Music M, Kadiec M , Zgajnar J, Besic N, Pogacnik A et al "Role of ultrasound in the preoperative staging of patients with breast cancer" EurRadiol 2005; 15:1044-1055Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM "Axillary lymph nodes suspicious for breast cancer metastasis: sampling with...
Personal Information
Maite Mellado.Servicio de Radiología. Hospital de Navarra.C/Irunlarrea s/nPamplona.
[email protected]