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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
Purpose
Axillary lymph node staging is one of the most important prognostic indicator of outcome in patients with breast cancer [1].
Currently,
sentinel lymph node biopsy is used as an initial approach of the axilla in most patients with breast cancer [2].
With the development of adjuvant treatment studies have shown that depending on the tumor characteristics the approach of the axilla can be less invasive [3].
Ultrasound has been used as the primary imaging method to evaluate axillary lymph nodes in breast cancer in several studies,
as it is an inexpensive method,
which also allows biopsies.
Many studies have been performed to correlate the sonographic findings of lymph nodes with metastatic involvement.
It is now known that cortical thickening,
obliteration of the fatty hilum and rounded shape are predictors of malignancy [4,5].
Ultrasound-guided axillary lymph node fine needle aspiration (FNA) showed in several studies adequate sensitivity and accuracy,
excellent specificity and positive predictive value in lymph node metastasis detection in preoperative exams of patients with breast cancer [6 -10] .
As FNA is a fast examination and is well tolerated by patients,
with limited adverse events,
it is ideal as a screening method.
Patients with preoperatively proven lymph node metastasis can go directly to axillary dissection or neoadjuvant therapy.
While patients with negative lymph nodes cytology,
are submitted to sentinel node biopsy.
It is known that the larger the size of the primary tumor,
the more beneficial will the lymph node FNA be.
For a larger tumor,
the lymph node metastasis tends to be larger and more frequent [10,
11].
Koelliker and colleagues [11] have also shown that the fine needle aspiration in lymph nodes with normal morphology at ultrasound can increase the sensitivity of metastasis detection,
particularly in patients with larger tumors.
The purpose of this study was to correlate the sonographic features of axillary lymph nodes in patients with primary invasive breast carcinoma with ultrasound-guided FNA results.
Furthermore,
we investigated the correlation between the sonographic features and the final pathology results from the sentinel lymphadenectomy or axillary lymph node dissection (ALND).
Our goal was to evaluate nodal features that could predict metastatic involvement and also the role of axillary lymph node FNA in the staging of patients with breast cancer.
Additionally we would like to assess whether depending on the tumor characteristics lymph nodes with normal ultrasound features could have metastatic involvement.