Abstract
Background
Sonographically directed fine-needle aspiration is a less invasive and less costly alternative to sentinel node (SN) mapping in breast cancer patients at high risk for metastatic disease but with clinically negative axillae.
Methods
Radiographic, cytological, and histological diagnostic data on breast primary tumors from 114 consecutive SN candidates were prospectively assessed for clinicopathologic variables associated with an increased incidence of axillary metastases. Patients in whom these variables were identified underwent sonographic examination of their axillae followed by fine-needle aspiration when abnormal nodes were detected. SN mapping was performed in patients with normal axillary sonogram results or negative cytological results. Patients with positive cytological results proceeded to complete axillary dissection. Final axillary histological outcomes from patients not meeting the high-risk criteria were recorded. Additionally, a cost analysis was performed in which the costs of ultrasonography and ultrasound-guided fine-needle aspiration of the axilla were compared with those of SN mapping.
Results
According to our selection criteria, a third of the patients with clinically negative axillae (37 of 114; 32%) were considered at high risk for axillary metastases. Fifty-nine percent of these patients (22 of 37) had metastatic disease on final histological analysis. Forty percent (15 of 37) of high-risk patients were spared SN mapping, with a reduction in health care costs of 20% in this patient population. Eighty-seven percent of patients not meeting high-risk criteria were SN negative.
Conclusions
This study suggests that in patients at increased risk for axillary metastases, the use of sonographic evaluation of the axilla in combination with fine-needle aspiration is not only clinically justified, but also cost-effective.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 2006;106:4–16
Hill AD, Tran KN, Akhurst T, et al. Lessons learned from 500 cases of lymphatic mapping for breast cancer. Ann Surg 1999;229:528–35
Veronesi U, Paganelli G, Viale G, et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999;91:368–73
Winchester DJ, Sener SF, Winchester DP, et al. Sentinel lymphadenectomy for breast cancer: experience with 180 consecutive patients—efficacy of filtered technetium 99m sulphur colloid with overnight migration time. J Am Coll Surg 1999;188:597–603
Tanis PJ, van Sandick JW, Nieweg OE, et al. The hidden sentinel node in breast cancer. Eur J Nucl Med Mol Imaging 2002;29:305–11
Rutledge H, Davis J, Chiu R, et al. Sentinel node micrometastasis in breast carcinoma may not be an indication for complete axillary dissection. Mod Pathol 2005;18:762–8
Weiser MR, Montgomery LL, Tan LK, et al. Lymphovascular invasion enhances the prediction of non-sentinel node metastases in breast cancer patients with positive sentinel nodes. Ann Surg Oncol 2001;8:145–9
Degnim AC, Griffith KA, Sabel MS, et al. Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients. Cancer 2003;98:2307–15
Abdessalam SF, Zervos EE, Prasad M, et al. Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer. Am J Surg 2001;182:316–20
Bedrosian I, Bedi D, Kuerer HM, et al. Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol 2003;10:1025–30
Bonnema J, van Geel AN, van Ooijen B, et al. Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg 1997;21:270–4
Damera A, Evans AJ, Cornford EJ, et al. Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer. Br J Cancer 2003;89:1310–3
de Kanter AY, van Eijck CH, van Geel AN, et al. Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg 1999;86:1459–62
Deurloo EE, Tanis PJ, Gilhuijs KG, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer 2003;39:1068–73
Krishnamurthy S, Sneige N, Bedi DG, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer 2002;95:982–8
Vaidya JS, Vyas JJ, Thakur MH, et al. Role of ultrasonography to detect axillary node involvement in operable breast cancer. Eur J Surg Oncol 1996;22:140–3
Verbanck J, Vandewiele I, De Winter H, et al. Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: a prospective study in 144 consecutive patients. J Clin Ultrasound 1997;25:53–6
Yang WT, Ahuja A, Tang A, et al. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med 1996;15:241–6
van Rijk MC, Deurloo EE, Nieweg OE, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol 2006;13:31–5
Elston C. Grading of invasive carcinoma of the breast. (1987) In: Page D, Anderson T, eds. Diagnostic Histopathology of the Breast. New York: Churchill Livingston, pp 300–11
Stavros T. (2003) Evaluation of regional lymph nodes in breast cancer patients. In: Breast Ultrasound. Philadelphia: Lippincott Williams & Wilkins, pp 855–64
Cox CE, Yeatman T, Salud CJ, Bass SS. Significance of sentinel node micrometastasis. Cancer Control 1999;6:601–5
den Bakker MA, van Weeszenberg A, de Kanter AY, et al. Non-sentinel lymph node involvement in patients with breast cancer and sentinel node micrometastasis; too early to abandon axillary clearance. J Clin Pathol 2002;55:932–5
Oruwari JU, Chung MA, Koelliker S, et al. Axillary staging using ultrasound-guided fine needle aspiration biopsy in locally advanced breast cancer. Am J Surg 2002;184:307–9
Khan A, Sabel MS, Nees A, et al. Comprehensive axillary evaluation in neoadjuvant chemotherapy patients with ultrasonography and sentinel lymph node biopsy. Ann Surg Oncol 2005;12:697–704
Rouzier R, Extra JM, Klijanienko J, et al. Incidence and prognostic significance of complete axillary downstaging after primary chemotherapy in breast cancer patients with T1 to T3 tumors and cytologically proven axillary metastatic lymph nodes. J Clin Oncol 2002;20:1304–10
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Davis, J.T., Brill, Y.M., Simmons, S. et al. Ultrasound-Guided Fine-Needle Aspiration of Clinically Negative Lymph Nodes Versus Sentinel Node Mapping in Patients at High Risk for Axillary Metastasis. Ann Surg Oncol 13, 1545–1552 (2006). https://doi.org/10.1245/s10434-006-9095-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-006-9095-8