Abstract
Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the accuracy of sonography in the diagnosis of loco-regional lymphatic recurrences in comparison to the core needle biopsy results. Materials and Methods: Among 6455 patients who were followed up with clinical examination, mammography and ultrasound between January 2004 and November 2011, 125 (1.93%) patients had to be investigated with a core needle biopsy of a sonographically suspicious loco-regional lymph node. Results: Among the whole series, a total of 142 ultrasound-guided core needle biopsies were performed. Follow-up for the primary tumor lasted for a median time of 6.1 years (range 1 - 27 years). Ultrasound of suspicious loco-regional lymph nodes showed a sensitivity of 89.5%, a specificity of 87.1% and a positive predictive value of 89.5%. Conclusions: In our experience, ultrasound of suspicious loco-regional lymph nodes showed good accuracy and it should be a part of the standard examinations performed during follow-up for breast cancer.
Highlights
The risk of locoregional recurrence (LRR) is related to the clinical staging and it is considered as an independent risk factor for distant metastasis and death; an early diagnosis in patients clinically negative could have a positive impact on survival compared to symptomatic patients [2,3]
The 2011 European Society of Medical Oncology (ESMO) guidelines [4], have not established a specific protocol for the follow-up of a patient with breast cancer (BC) as there is no evidence from randomized trials supporting any ideal sequence
In all cases the primary BC was surgically treated: 47 patients (37.6%) underwent mastectomy and axillary lymph node dissection (ALND), 78 patients (62.4%) underwent a quadrantectomy followed by either ALND (47 patients; 37.6%) or sentinel lymph node dissection (SLND) (31 patients; 24.8%)
Summary
The aims of the breast cancer (BC) follow-up are to find early locoregional and distant recurrences, to evaluate and treat therapies complications and to provide psychological support and information to help patients return to normal life. A BC locoregional recurrence (LRR) is defined as the re-appearance of disease in the area of the primary treatment and/or in the regional lymph nodes: axillary, supra- and infra-clavicular, parasternal or the internal mammary chain [1]. BC follow-up includes many investigations such as clinical examination, mammography and breast ultrasound (US). The aim of this study was to evaluate follow-up patients for previous BC, the diagnostic accuracy of US in studying loco-regional lymph nodes and its concordance to the core needle biopsy (CNB) reports
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