Preoperative Axillary US in Early-Stage Breast Cancer: Potential to Prevent Unnecessary Axillary Lymph Node Dissection.
Ga Ram KimWoo Kyung MoonBoo-Kyung HanJeong Eon LeeSeok Jin NamEun Young KoEun Sook KoSe Kyung LeePublished in: Radiology (2018)
Purpose To evaluate the value of preoperative axillary ultrasonography (US) for preventing unnecessary axillary lymph node dissection after sentinel lymph node (SLN) biopsy in a large series of patients with early-stage breast cancers treated with both breast-conserving surgery and SLN biopsy. Materials and Methods From March 2009 to February 2013, 1802 patients who underwent breast-conserving surgery for clinical T1-2/N0 cancers and SLN biopsy with or without axillary lymph node dissection were included. Preoperative axillary US results and clinical-pathologic variables were compared according to the status of non-SLN metastasis. Multivariate logistic regression analysis was performed to find factors associated with non-SLN metastasis. Results Of 1802 patients, 397 (22.0%) underwent axillary lymph node dissection due to positive SLN biopsy and 76 (4.2%) had non-SLN metastasis at final histopathologic examination. Patients with non-SLN metastasis were younger and showed positive axilla at US and clinical T2 stage more frequently (P < .05). At multivariate analysis, positive axilla at US (P = .001), clinical T2 stage (P = .005), and lymphovascular invasion (P < .001) were significantly associated with non-SLN metastasis. Among 1284 patients with negative axilla at US and clinical T1 stage cancer, 1254 (97.7%) did not have non-SLN metastasis and 30 (2.3%) had non-SLN metastasis. Conclusion Preoperative axillary US results and clinical T stage are associated with the status of non-SLN metastasis in patients with early breast cancer. The results of this study suggest that preoperative axillary US can help select patients at minimal risk of non-SLN metastasis, for whom axillary lymph node dissection can be omitted. © RSNA, 2018 Online supplemental material is available for this article.
Keyphrases
- sentinel lymph node
- early stage
- neoadjuvant chemotherapy
- lymph node
- newly diagnosed
- patients undergoing
- locally advanced
- minimally invasive
- magnetic resonance imaging
- end stage renal disease
- computed tomography
- healthcare
- magnetic resonance
- early breast cancer
- prognostic factors
- radiation therapy
- coronary artery bypass
- atrial fibrillation
- coronary artery disease
- risk assessment
- data analysis