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Keywords:
Breast, Lymph nodes, Interventional non-vascular, Ultrasound, Biopsy, Cancer
Authors:
P. Akissue de Camargo Teixeira, N. de Barros, L. F. Chala, C. Shimizu, J. R. Filassi; São Paulo/BR
DOI:
10.1594/ecr2015/B-0111
Conclusion
In patients with newly diagnosed invasive breast cancer axillary ultrasound and ultrasound-guided FNA are a useful method of screening,
helping to decide which is the better systemic and axillary approach.
Depending on ultrasound and tumor characteristics we could spare FNA and direct the patient to sentinel lymphadenectomy or neoadjuvant treatment.
In our study,
ultrasound-guided FNA brought no benefit in patients with axillary lymph nodes classified on ultrasound as normal,
independently of tumor characteristics.
All FNA cytology results were negative or inconclusive when the lymph nodes had normal appearance on ultrasound.
Lymph nodes ultrasound features most associated with malignancy were diffuse cortical thickening and partial or complete fatty hilum obliteration,
in the subgroup without neoadjuvant treatment.
In the subgroup with neoadjuvant treatment it was not possible to establish differences between the ultrasound characteristics of the lymph nodes that could predict metastatic involvement,
probably because the vast majority of lymph nodes was abnormal.
In this subgroup only eight patients had lymph nodes that were considered abnormal on ultrasound and of these only one patient had metastatic lymph nodes in surgical pathology.
In conclusion,
our study showed that ultrasound is useful in differentiating lymph nodes with metastatic involvement in patients with primary invasive breast cancer.
Patients with normal sonographic lymph nodes features could be spared from FNA and go straight to sentinel lymphadenectomy.
Also,
patients with T3 and T4 tumors and abnormal lymph nodes on ultrasound,
that did not benefit from ultrasound-guided FNA in our study,
could be directed to neoadjuvant treatment after abnormal ultrasound.
The patients who benefited the most from FNA were the ones with stage T1 and T2 with abnormal sonographic lymph nodes features,
since this population was candidate for sentinel lymphadenectomy.