Rol de la ecografía y punción con aguja fina en el manejo de la axila en pacientes con cáncer mamario, en la era posterior al ACOSOG Z0011

Abstract

ObjectiveTo determine whether ultrasound and ultrasound-guided fine-needle aspiration in patients with breast cancer who meet the ACOSOG Z0011 selection criteria can identify those with high axillary involvement (more than 2 lymph nodes with macrometastases). Material and methodsA total of 115 consecutive patients with breast cancer (up to 5cm in diameter), with clinically negative axilla and pathologically positive axilla. All patients underwent preoperative axillary ultrasound. Ultrasound-guided fine-needle aspiration cytology was performed in patients with suspicious nodes on ultrasound. In all patients with positive cytology, lymphadenectomy was performed. In all patients with negative ultrasound and cytology, sentinel lymph node biopsy was performed, and when it was positive, lymphadenectomy was performed. The number of pathological lymph nodes was evaluated after lymphadenectomy. ResultsA total of 61 patients had positive ultrasound and axillary cytology. In 42 of them (69%), there were more than 2 pathological lymph nodes. There were 54 patients with negative ultrasound and axillary cytology. In 49 of them (90%), there were only 1 or 2 pathological lymph nodes. Axillary ultrasound and fine-needle aspiration cytology were able to identify 42 of the 47 patients (89%) with more than 2 pathological lymph nodes. ConclusionIn patients with breast cancer who meet the ACOSOG Z0011 selection criteria, ultrasound and ultrasound-guided fine-needle aspiration can accurately identify those with high axillary involvement (more than 2 lymph nodes with macrometastasis), which would benefit from lymphadenectomy.