Efficiency of a preoperative axillary ultrasound and fine-needle aspiration cytology to detect patients with extensive axillary lymph node involvement.

Isabella Castellano,Francesca Muscarà,Paola Cassoni,Riccardo Bussone,Guglielmo Gazzetta,Luigia Macrì,Anna Sapino,Luigi Chiusa,Cristina Deambrogio,Giovanna Mariscotti,Robert L Schmidt

doi:10.1371/journal.pone.0106640

Abstract

BackgroundRecent studies have demonstrated that axillary lymph node dissection (ALND) does not affect patient survival, even in those with one or two positive sentinel lymph nodes (SLNs). On the other hand, patients with 3 or more metastatic lymph nodes are eligible for chemotherapy. Therefore, it is crucial to identify a priori patients at risk of having a high number of metastatic axillary lymph nodes for their surgical and/or clinical management. Ultrasound (US) guided Fine-Needle Aspiration (FNA) has been proven to be a useful and highly specific method for detecting metastatic axillary lymph nodes. However, only one recent study has evaluated the efficiency of this method in identifying patients with high metastatic nodal involvement. Our aim was to validate US-guided FNA as a reliable method to discriminate a priori patients with >3 metastatic lymph nodes.MethodsA retrospective series of 1287 breast cancer patients who underwent a simultaneous preoperative breast and axillary US to stage their axilla was collected. A total of 365 patients, with either positive SLNs (278) or positive axillary lymph nodes detected via US-guided FNA (87), underwent ALND. In these two subgroups, we compared the number of metastatic lymph nodes in the axilla.ResultsThe number of metastatic axillary lymph nodes in patients who underwent US-guided FNA was significantly higher (63% had >3 metastatic lymph nodes) than that in patients with SLNs positive for micro- or macrometastases (3% and 27%, respectively) (P<0.001, χ 2 = 117.897).ConclusionsPreoperative axillary US-guided FNA could act as a reliable tool in identifying breast cancer patients with extensive nodal involvement.

Highlights

The sentinel lymph node (SLN) biopsy has been considered the standard technique in staging axillary lymph nodes in breast cancer patients [1]
Traditional protocols indicate that breast cancer patients with positive SLNs require a thorough examination of their axillary lymph nodes, while patients with negative SLNs can skip axillary lymph node dissection (ALND)
Other studies [3,4] have reported that only 30% of patients with positive SLNs showed involvement of other axillary lymph nodes and that axillary recurrence in patients not treated with ALND was uncommon

Summary

Introduction

The sentinel lymph node (SLN) biopsy has been considered the standard technique in staging axillary lymph nodes in breast cancer patients [1]. This study did not detect any differences in survival among patients with T1–T2 breast cancer, with one or two positive SLNs, treated with breast conservation and systemic therapy alone or with ALND. The status of axillary lymph nodes remains an important prognostic index of overall and disease-free survival, and the number of metastatic nodes is considered by oncologists when deciding whether to administer chemotherapy, mainly in patients with estrogen receptor (ER)-positive cancer [5]. Recent studies have demonstrated that axillary lymph node dissection (ALND) does not affect patient survival, even in those with one or two positive sentinel lymph nodes (SLNs). It is crucial to identify a priori patients at risk of having a high number of metastatic axillary lymph nodes for their surgical and/or clinical management. Our aim was to validate US-guided FNA as a reliable method to discriminate a priori patients with .3 metastatic lymph nodes

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