Abstract
BackgroundBreast cancer patients with suspicious axillary lymph node (ALN) at ultrasound and positive fine-needle aspiration (FNA) results were required to receive ALN dissection (ALND), which was not certain in the post-ACOSOG Z0011 era. We aim to evaluate the ALN metastasis burden in these patients, thus to illustrate whether they can follow the ACOSOG Z0011 trial procedure.MethodsClinically, T1–2 N0 breast cancer patients with positive preoperative ALN biopsy (FNA group) or 1–2 positive sentinel nodes (SLNB group) were retrospectively analyzed. ALN metastasis burden was compared between the two groups, which were further analyzed in certain subtypes. An association between clinicopathological factors and ≥ 3 ALN metastasis was also analyzed.ResultsA total of 388 patients were included: 202 in the FNA group and 186 in the SLNB group. The FNA group had a significantly higher number of positive ALN (5.18 vs. 1.77, P < 0.001) and a larger proportion of patients with ≥ 3 ALN metastasis (58.42% vs. 11.83%, P < 0.001) than the SLNB group, which was not influenced by different tumor size stage and molecular subtypes. ALN metastasis identified by FNA was independently associated with a high rate of ≥ 3 ALN metastasis (OR = 6.98, 95% CI 1.95–25.02, P = 0.003).ConclusionsPatients with positive preoperative ALN biopsy had a higher ALN metastasis burden than patients with 1–2 positive SLNs, which was also the strongest factor associated with ≥ 3 ALN metastasis, indicating that these patients are not appropriate to receive SLNB in the post-ACOSOG Z0011 trial era.
Highlights
Breast cancer patients with suspicious axillary lymph node (ALN) at ultrasound and positive fine-needle aspiration (FNA) results were required to receive ALN dissection (ALND), which was not certain in the post-American College of Surgeons Oncology Group (ACOSOG) Z0011 era
Our current study found that T1–2 N0 breast cancer patients with suspicious ALN at ultrasound and positive FNA results (FNA group) had more ALN metastasis and a higher proportion of patients with ≥ 3 ALN metastasis compared with 1–2 sentinel lymph node (SLN)-positive patients (SLNB group), which was consistent in different tumor stage and molecular subtypes
Our study found that ALN metastasis burden was significantly higher in the FNA group than in the sentinel lymph node biopsy (SLNB) group irrespective of molecular subgroups, indicating that routine clinicopathological factors may not be enough to select FNA-positive patients to receive ALN surgery according to the ACOSOG Z0011 trial procedure
Summary
Breast cancer patients with suspicious axillary lymph node (ALN) at ultrasound and positive fine-needle aspiration (FNA) results were required to receive ALN dissection (ALND), which was not certain in the post-ACOSOG Z0011 era. Axillary lymph node (ALN) surgery is an important part of the surgical management of early breast cancer patients, which improves local disease control and guides further adjuvant systemic treatment [1, 2]. Sentinel lymph node biopsy (SLNB) is firstly recommended for clinical ALN-negative patients. For patients with positive sentinel lymph node (SLN), axillary lymph node dissection (ALND) is the standard management for patients who do not receive breast-conserving surgery. For patients with suspicious ALN at ultrasound, ultrasound-guided FNA is a convenient and accurate method for preoperative ALN evaluation [4, 5]. Patients with positive FNA results are recommended to receive ALND, which can avoid unnecessary SLNB [6, 7]
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