Keywords:
Breast, Lymph nodes, Oncology, Ultrasound, Biopsy, Cancer
Authors:
N. Alberdi1, N. Baraibar Argota1, I. Baraibar1, P. Lopez Sala1, M. Mellado1, S. Cervantes1, P. L. Alejandre García1, I. Sanmartin2, N. Alonso Ordás1; 1Pamplona/ES, 2Tudela/ES
DOI:
10.26044/ecr2019/C-1503
Methods and materials
We conducted a retrospective study of 114 patients with LADBC that received neoadjuvant treatment in our institution between 2011 and 2017 ( Fig. 1 ).
Initial axillary lymph node sonographic evaluation was conducted in all patients.
Six different radiologists evaluated the axillary status.
Nodal features assessed were the shape and the morphology of the cortex and lymph nodes were classificated according to Bedi’s criteria into positive (types 5 and 6) or negative (types 1-4).
When pathologic lymph nodes were detected,
a core needle biopsy (CNB) or fine needle aspiration (FNA) was performed.
Five different pathologists participated in the evaluation of the samples.
According to available literature,
25% of negative ultrasound-guided axillary lymph node biopsies have a positive SLN [11],
so if the anatomopathological study was negative or not suspicious lymph nodes were detected by ultrasound,
patients underwent sentinel lymph node biopsy (SLNB).
Fig. 1: ASSESSMENT OF AXILLARY NODAL STATUS BEFORE NEOADJUVANT CHEMOTHERAPY
Axillary lymph node involvement was found in 91 patients (79.8%).
The AU was pathological in 81 cases (71%), with histological confirmation in 76 (93.8%). 45.5% of patients with normal AU who underwent SLNB had histologically confirmed lymph node disease.
Axillary response was evaluated by ultrasonography after completing neoadjuvant chemotherapy.
If histologically confirmed lymph node involvement at diagnosis,
lymphadenectomy was performed.
Lymph node regression was evaluated according to Miller-Payne classification [12]:
- Type A: No nodal metastasis or therapeutic effect.
- Type B: Positive lymph nodes and no therapeutic effects.
- Type C: Positive lymph nodes but evidence of partial pathologic response.
- Type D: Negative lymph nodes,
therapeutic effect present.