Association between negative preoperative axillary node staging and surgical sentinel node biopsy in patients with newly diagnosed breast cancer: A retrospective analysis.

Lucia Veverkova,Nora Zlamalova,Rohit Philip Thomas,Katherine Vomackova,Bohuslav Melichar,Marketa Koleckova

doi:10.5507/bp.2020.005

Lucia Veverkova, Nora Zlamalova + Show 4 more

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https://doi.org/10.5507/bp.2020.005

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Journal: Biomedical Papers	Publication Date: Feb 25, 2020
License type: CC BY 4.0

Affiliation: Palacký University, Olomouc

Abstract

The aim of this retrospective study was to analyse the preoperative ultrasound findings in patients with minimal or almost no morphological changes of axillary lymph nodes (LN) and to correlate these findings with the results of sentinel node (SN) biopsy. Between January 2014 and September 2018, 289 female patients with newly diagnosed breast cancer and negative preoperative axillary staging were examined with preoperative ultrasound evaluation of axillary LNs. Patients with no evidence of LN metastases underwent primary surgical treatment with SN biopsy. Negative predictive value (NPV) of preoperative ultrasound was evaluated and the histopathological findings in positive SN biopsies were correlated with tumour type and preoperative ultrasound LN imaging. Of 289 patients with negative preoperative axillary staging who had primary surgical treatment, 268 patients had negative SN biopsy while SN metastases were detected in 21 patients. Of patients with positive SN biopsies, 2 patients had negative core biopsy of axillary LN before surgery. The preoperative ultrasound examination was negative in the remaining 19 patients with SN metastases. Preoperative ultrasonography is very accurate in the detecting of axillary LN metastases. Patients with primary tumour size ≥ 1 cm, with grade ≥ 2 no special type carcinomas (NST - no special type, also known as invasive ductal carcinoma) or multicentric lobular invasive cancer should undergo a more thorough ultrasound evaluation.

Highlights

Ipsilateral axillary lymph node (LN) metastases are common in breast cancer patients[1] and have important prognostic implications
In the retrospective analysis of the standard images of ultrasound findings in 21 women with positive sentinel node biopsy, cortex thickening of more than 2 mm was evident in 5 cases, 3 cases with cortex thickening without core biopsy and 2 cases with cortex thickening with negative preoperative core biopsy
Of 3 cases without preoperative core biopsy one exhibited diffuse cortex thickening of 3.5 mm with the metastasis growing through the node capsule and that was underestimated on preoperative ultrasound

Summary

Introduction

Ipsilateral axillary lymph node (LN) metastases are common in breast cancer patients[1] and have important prognostic implications. The risk of axillary LN metastases is associated with the size of primary tumour at diagnosis, tumour grade, the presence of lymphovascular invasion, and multifocality or multicentricity of the tumour. Axillary LN staging is a crucial component in the management strategy of primary therapy. The staging of breast cancer routinely includes an ultrasound axillary LN evaluation[1,2,3,4,5,6]. All patients with newly diagnosed breast cancer undergo an ultrasonographical axillary LN staging. All clearly pathological nodes are not necessarily verified by biopsy[6]. This is in cases for instance with distant metastases and pathological axillary LN

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