Does ‘fast – track’ axillary node clearance following positive core biopsy lead to overtreatment of axilla?

The Surgeon ◽  
2020 ◽  
Author(s):  
Muhammad Abdullah ◽  
Velin Voynov ◽  
Paul Stonelake
Keyword(s):  
Core Biopsy ◽  
Fast Track ◽  
Axillary Node ◽  
Axillary Node Clearance ◽  
Positive Core

scholarly journals EP.TH.879Does ‘fast -track’ axillary node clearance following positive core biopsy lead to overtreatment of axilla?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Muhammad Abdullah ◽  
Velin Voynov ◽  
Paul Stonelake
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Axillary Dissection ◽  
Fast Track ◽  
Neoadjuvant Treatment ◽  
Axillary Node ◽  
Breast Cancer Patients ◽  
Axillary Node Clearance ◽  
Positive Core ◽  
Group B

Abstract Aims Axillary node clearance (ANC) can cause lifelong disability and conservative axillary dissection is increasingly preferred. However, direct (fast-track) ANC after preoperative axillary biopsy is still performed, which may be overtreating the patients with low axillary burden. This study aims to identify if direct (fast- track) ANC leads to overtreatment of axilla. Methods Retrospective data for all breast cancer patients who underwent surgery between 1 January 2017 and 31 December 2018 were included in this study. The histopathology results of ANC were correlated with axillary ultrasound findings, axillary biopsy or SLNB results and effect of neoadjuvant treatment. These were analysed against the available guidelines to evaluate the current practice. Results 82 patients out of 520 had ANC (15.7%). Four groups were identified. 35.5% of patients diagnosed with nodal infiltration on preoperative biopsy (Group A) had only 1- 2 positive nodes following ANC. Complete pathological response was observed in 37.5% patients with nodal infiltration who had ANC following neoadjuvant chemotherapy (NACT) (Group B). No further nodes were subsequently found in 63.6% of patients who underwent ANC following positive SLNB (Group C). Group D included 2 patients with axillary recurrence. Conclusions 15.7% of breast cancer patients required ANC. The practice of direct (fast-track) ANC after axillary biopsy leads to overtreatment of the axilla, which needs re-evaluation. Targeted axillary dissection could avoid unnecessary axillary dissection in patients with abnormal nodes. This is now recommended in patients who have received NACT but has not been evaluated yet in patients with up front surgery.

TP8.1.1 Does ultrasound quantification of suspicious axillary nodes correlate with pathological results?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Muhammad Abdullah
Keyword(s):  
Breast Cancer ◽  
Fast Track ◽  
Axillary Node ◽  
Retrospective Data ◽  
Breast Cancer Patients ◽  
Axillary Ultrasound ◽  
Axillary Nodes ◽  
Axillary Node Clearance ◽  
Ultrasound Findings ◽  
Abnormal Node

Abstract Aims Fast-track axillary node clearance (ANC) leads to overtreatment of axilla. Improved quantification by axillary US (AUS) is suggested to avoid unnecessary ANC and proceed with ANC or SLNB based on the number of abnormal axillary nodes. This retrospective study was aimed to evaluate whether ANC can be omitted based on AUS quantification in patients with low axillary burden. Methods Retrospective data of breast cancer patients who underwent ANC following a positive pre-operative axillary nodal biopsy between 1 January 2017 and 31 December 2018 were included in this study. The patients who received neoadjuvant chemotherapy, those having ANC following positive SLNB and those with axillary recurrence were excluded. The histopathology results of ANC were correlated with axillary ultrasound findings. Results 45 patients underwent fast-track ANC following positive axillary core biopsy. On pre-operative AUS, 18 of these patients were reported to have a single abnormal node, while 8 had two abnormal nodes and 19 patients had multiple abnormal nodes. The comparison of the number of metastatic nodes following ANC, and the reported abnormal nodes on pre-operative AUS, showed that 57.3% of patients with 1 – 2 abnormal nodes on AUS had 3 or more metastatic nodes and 26.3% of patients with multiple abnormal nodes on AUS had 1 – 2 metastatic nodes following ANC. Conclusions The quantification of the axillary burden with pre-operative AUS does not correlate with the number of metastatic axillary nodes. The reported relevant axillary burden on AUS is not sufficiently specific to form the basis of omission of ANC.

scholarly journals Breast MRI and tumour biology predict axillary lymph node response to neoadjuvant chemotherapy for breast cancer

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Samia Al-Hattali ◽  
Sarah J. Vinnicombe ◽  
Nazleen Muhammad Gowdh ◽  
Andrew Evans ◽  
Sharon Armstrong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Core Biopsy ◽  
Breast Surgery ◽  
Complete Response ◽  
Breast Tumour ◽  
Nodal Metastasis ◽  
Axillary Node ◽  
Tumour Type ◽  
Axillary Node Clearance

Abstract Background In patients who have had axillary nodal metastasis diagnosed prior to neoadjuvant chemotherapy for breast cancer, there is little consensus on how to manage the axilla subsequently. The aim of this study was to explore whether a combination of breast magnetic resonance imaging (MRI) assessed response and primary tumour pathology factors could identify a subset of patients that might be spared axillary node clearance. Methods A retrospective data analysis was performed of patients with core biopsy-proven axillary nodal metastasis prior to commencement of neoadjuvant chemotherapy (NAC) who had subsequent axillary node clearance (ANC) at definitive breast surgery. Breast tumour and axillary response at MRI before, during and on completion of NAC, core biopsy tumour grade, tumour type and immunophenotype were correlated with pathological response in the breast and the number of metastatic nodes in the ANC specimens. Results Of 87 consecutive patients with MRI at baseline, interim and after neoadjuvant chemotherapy who underwent ANC at time of breast surgery, 33 (38%) had no residual macrometastatic axillary disease, 28 (32%) had 1–2 metastatic nodes and 26 (30%) had more than 2 metastatic nodes. Factors that predicted axillary nodal complete response were MRI complete response in the breast (p < 0.0001), HER2 positivity (p = 0.02) and non-lobular tumour type (p = 0.015). Conclusion MRI assessment of breast tumour response to NAC and core biopsy factors are predictive of response in axillary nodes, and can be used to guide decision making regarding appropriate axillary surgery.

1573: Pathologic Characteristics of Contralateral Prostate Cancer Among Patients with a Single Positive Core Biopsy

2006 ◽  
Vol 175 (4S) ◽  
pp. 507-507 ◽  
Author(s):  
Theodore Barber ◽  
Vaishali Pansare ◽  
Dimitriy Nikolavsky ◽  
J. Edson Pontes ◽  
Wael Sakr ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Core Biopsy ◽  
Positive Core ◽  
Single Positive

Can machine learning be used to reduce overtreatment of the axilla in breast cancer? Results from a retrospective cohort study (Preprint)

2021 ◽  
Author(s):  
Felix Jozsa ◽  
Rose Baker ◽  
Peter Kelly ◽  
Muneer Ahmed ◽  
Michael Douek
Keyword(s):  
Breast Cancer ◽  
Machine Learning ◽  
Axillary Node ◽  
Machine Learning Techniques ◽  
Data Sets ◽  
Axillary Ultrasound ◽  
Primary Surgery ◽  
Large Patient ◽  
Specificity And Sensitivity ◽  
Axillary Node Clearance

BACKGROUND Patients with early breast cancer undergoing primary surgery who have low axillary nodal burden can safely forego axillary node clearance (ANC). However, routine use of axillary ultrasound (AUS) leads to 43% of patients in this group having ANC unnecessarily following a positive AUS. The intersection of machine learning with medicine can provide innovative ways to understand specific risk within large patient data sets, but this has not yet been trialled in the arena of axillary node management in breast cancer. OBJECTIVE To assess if machine learning techniques could be used to improve pre-operative identification of patients with low and high axillary metastatic burden. METHODS A single-centre retrospective analysis was performed on patients with breast cancer who had a preoperative axillary ultrasound, and the specificity and sensitivity of AUS were calculated. Machine learning and standard statistical methods were applied to the data to see if, when used preoperatively, they could have improved the accuracy of AUS to better discern between high and low axillary burden. RESULTS The study included 459 patients; 31% (n=142) had a positive AUS, and, among this group, 62% (n=88) had two or fewer macrometastatic nodes at ANC. When applied to the dataset, logistic regression outperformed AUS and machine learning methods with a specificity of 0.950, correctly identifying 66 patients in this group who had been incorrectly classed as having high axillary burden by AUS alone. Of all the methods, the artificial neural network had the highest accuracy (0.919). Interestingly, AUS had the highest sensitivity of all methods (0.777), underlining its utility in this setting. CONCLUSIONS Machine learning greatly improves identification of the important subgroup of patients with no palpable axillary disease, positive ultrasound, and more than two metastatically involved nodes. A negative ultrasound in patients with no palpable lymphadenopathy is highly indicative of low burden and it is unclear if sentinel node biopsy adds value in this situation. CLINICALTRIAL n/a

scholarly journals Ultrasound Guided Core Biopsy versus Fine Needle Aspiration for Evaluation of Axillary Lymphadenopathy in Patients with Breast Cancer

ISRN Oncology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Marie A. Ganott ◽  
Margarita L. Zuley ◽  
Gordon S. Abrams ◽  
Amy H. Lu ◽  
Amy E. Kelly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fine Needle Aspiration ◽  
Core Biopsy ◽  
Needle Aspiration ◽  
Axillary Node ◽  
Axillary Lymph ◽  
Ultrasound Guided ◽  
Axillary Lymph Node Metastases ◽  
Fine Needle ◽  
Node Metastases

Rationale and Objectives. To compare the sensitivities of ultrasound guided core biopsy and fine needle aspiration (FNA) for detection of axillary lymph node metastases in patients with a current diagnosis of ipsilateral breast cancer. Materials and Methods. From December 2008 to December 2010, 105 patients with breast cancer and abnormal appearing lymph nodes in the ipsilateral axilla consented to undergo FNA of an axillary node immediately followed by core biopsy of the same node, both with ultrasound guidance. Experienced pathologists evaluated the aspirate cytology without knowledge of the core histology. Cytology and core biopsy results were compared to sentinel node excision or axillary dissection pathology. Sensitivities were compared using McNemar’s test. Results. Of 70 patients with axillary node metastases, FNA was positive in 55/70 (78.6%) and core was positive in 61/70 (87.1%) (P = 0.18). The FNA and core results were discordant in 14/70 (20%) patients. Ten cases were FNA negative/core positive. Four cases were FNA positive/core negative. Conclusion. Core biopsy detected six (8.6%) more cases of metastatic lymphadenopathy than FNA but the difference in sensitivities was not statistically significant. Core biopsy should be considered if the node is clearly imaged and readily accessible. FNA is a good alternative when a smaller needle is desired due to node location or other patient factors. This trial is registered with NCT01920139.

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