Adding ultrasound examination of axillary nodes and fine-needle aspiration of suspicious nodes prior to lumpectomy in women with early-stage breast cancer spared 17 (30%) of 57 women the need for sentinel node biopsy and a second surgery, a study of 274 patients found.
The 17 patients with cancerous lymph cells on axillary ultrasound and fine-needle aspiration cytology (AUS-FNAC) underwent axillary clearance at the same time as lumpectomy, Dr. Bedanta Baruah reported Oct. 6 in a press briefing sponsored by the American Society of Clinical Oncology.
Traditionally, women with a suspicious breast lump undergo FNAC or core needle biopsy to determine malignancy. Those with malignancies usually undergo sentinel lymph node biopsy at the time of lumpectomy and, in many parts of the world, results of the sentinel node biopsy are not available for several days, necessitating a second surgery for those with positive lymph nodes. At Dr. Baruah's institution, Cardiff (Wales) University, sentinel node biopsy results are available 3 days after surgery.
“Even in the [United States] and other centers where results of the sentinel biopsy are usually available at the time of initial surgery, using this technique would still prevent a very high number of unnecessary sentinel node biopsies,” he said. “We therefore recommend that all patients who are due for a lumpectomy should have this procedure before the formal surgery.”
Dr. Baruah reported having no conflicts of interest related to this study.
Dr. Lori Pierce, moderator of the press briefing and professor of radiation oncology at the University of Michigan, Ann Arbor, commented, “Patients diagnosed with early-stage breast cancer should discuss with their doctors the best method of determining whether cancer cells have gone to their lymph nodes under the arm.”
All patients who were scheduled to undergo breast conservation surgery in the Cardiff breast unit in 2007 and 2008 underwent AUS-FNAC at the time of initial diagnostic breast biopsy. Those with positive axillary nodes underwent axillary clearance at the time of lumpectomy, and those with negative nodes on AUS-FNAC underwent sentinel lymph node biopsy during lumpectomy.
In all, 57 patients (21%) had nodal macrometastases on final histology. The 17 identified by AUS-FNAC gave the procedure a sensitivity of 30%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 84%, with an overall accuracy of 84%,.
Previous studies used ultrasound alone to try and detect axillary metastases, which resulted in many false positives; the addition of FNAC eliminated false positives, he noted. Micrometastases in seven patients went undetected by AUS-FNAC, however, so any patient with normal results on AUS-FNAC still should undergo sentinel node biopsy, Dr. Baruah suggested. The importance of detecting micrometastases is not clear, Dr. Baruah said, but his unit offers patients with micrometastases axillary clearance, to be safe.