Does combined pre-operative axillary ultrasound scan and blue dye guided axillary lymph node sampling allow appropriate surgery for breast cancer without recourse to a radioactive tracer?

Abstract Background:Axillary ultrasound (AUS) is one of the important bases for evaluating the axillary status of breast cancer patients. And it would be helpful for the reassessment of axillary lymph node status in these patients after neoadjuvant chemotherapy(NAC) and guide the selection of their axillary surgical options.The purpose of this study was to evaluate the diagnostic performance of ultrasound,and to find out the factors related to the outcome of ultrasound.Methods:In this retrospective analysis, 172 patients (one bilateral breast cancer) with breast cancer and clinical positive axillary nodes, were enrolled. After NAC, all patients received mastectomy and axillary lymph node dissection (ALND). AUS was used before and after NAC to assess the axilla status. Results:Of the 173 axillae, 137 (79.19%) had pathological metastasis after NAC. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of axillary ultrasound in this cohort were 68.21%, 69.34%, 63.89%, 87.96% and 35.38% respectively. Univariate analysis showed that primary axillary lymph node(ALN) short axis, progesterone receptors, hormone receptors, the tumor status after NAC, tumor reduction rate, ALN short axis after NAC, physical examination of axilla after NAC and pN impacted the results of AUS(P = 0.000 ~ 0.040). Multivariate analysis of the above indicators showed that ALN short axis after NAC and pN associated with AUS results independently. Conclusion:AUS can accurately assess axilla status after NAC in most breast cancer patients. If the short axis of ALN≥10mm and AUS negative, SLNB could be chosen. However, AUS cannot detect residual lymph node disease after NAC in a short axis of the ALN <10mm.

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Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer

Journal of Oncology ◽

10.1155/2019/8637895 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Xiaokai Ma ◽

Shishuai Wen ◽

Baofeng Liu ◽

Dumin Li ◽

Xiaolong Wang ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Upper Extremity ◽

Axillary Lymph Node ◽

Lymphatic Drainage ◽

Sentinel Lymph Nodes ◽

Blue Dye ◽

Axillary Lymph ◽

Axillary Reverse Mapping

Purpose. The purpose of this study was to identify the relationship between upper extremity lymphatics and sentinel lymph nodes (SLNs) in breast cancer patients.Methods. Forty-four patients who underwent axillary reverse mapping (ARM) during axillary lymph node dissection (ALND) with SNL biopsy (SLNB) between February 2017 and October 2017 were investigated. ARM was performed using indocyanine green (ICG) to locate the upper extremity lymphatics; methylene blue dye was injected intradermally for SLN mapping.Results. ARM nodes were found in the ALND fields of all examined patients. The rate of identification of upper extremity lymphatics within the SLNB field was 65.9% (29 of 44). The ARM nodes were involved in metastases arising from primary breast tumors in 7 of the patients (15.9%), while no metastases were detected in pathologic axillary lymph node-negative patients. Lymphatics from the upper extremity drained into the SLNs in 5 of the 44 patients (11.4%); their ARM-detected nodes were found to be in close proximity to the SLNs.Conclusions. The ARM nodes and SLNs are closely related and share lymphatic drainage routes. The ARM procedure using fluorescence imaging is both feasible and, in patients who are SLN negative, oncologically safe. ARM using ICG is therefore effective for identifying and preserving upper extremity lymphatics, and SLNB combined with ARM appears to be a promising surgical refinement for preventing upper extremity lymphoedema.Clinical Trial Registration. This trial is registered with ClinicalTrial.gov:NCT02651142.

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Axillary ultrasound and fine-needle aspiration cytology to predict clinically relevant nodal burden in breast cancer patients

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02391-3 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Isabela Panzeri Carlotti Buzatto ◽

Francisco José Cândido dos Reis ◽

Jurandyr Moreira de Andrade ◽

Tamara Cristina Gomes Ferraz Rodrigues ◽

Jéssica Maria Camargo Borba ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Fine Needle Aspiration ◽

Axillary Lymph Node ◽

Needle Aspiration ◽

Axillary Lymph ◽

Axillary Ultrasound ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology

Abstract Background Axillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years. This study evaluated if axillary ultrasound (US) coupled with fine-needle aspiration cytology (FNAC) can accurately predict clinically relevant node metastasis in patients with breast cancer, and thus assist clinical decisions Methods This is a cross-sectional study with retrospective data collection of 241 individuals (239 women and 2 men) with unilateral operable breast cancer who were submitted to preoperative axillary assessment by physical exam, US and FNAC if suspicious nodes by imaging. We calculated sensitivity, specificity, and accuracy of the methods. We compared the patient's characteristics using chi-square test, parametrics and non-parametrics statistics according to the variable. Results The most sensible method was US (0.59; 95% CI, 0.50–0.69), and the most specific was US coupled with FNAC (0.97; 95% CI, 0.92–0.99). Only 2.7% of the patients with normal axillary US had more than 2 metastatic nodes in the axillary lymph node dissection, against 50% of the patients with suspicious lymph nodes in the US and positive FNAC. Conclusions Axillary US coupled with FNAC can sort patients who have a few metastatic nodes at most from those with heavy axillary burden and could be one more tool to initially evaluate patients and define treatment strategies.

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