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

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.

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

British Journal of Surgery ◽

10.1093/bjs/znab309.089 ◽

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.

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

10.2196/preprints.34600 ◽

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

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Re-evaluating the efficacy of axillary ultrasound in the detection of nodal metastasis and its impact on clinical practice.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.4 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 4-4

Author(s):

B. Lee ◽

A. Lim ◽

J. Krell ◽

K. Satchithananda ◽

J. S. Lewis ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Cortical Thickness ◽

Axillary Node ◽

Axillary Node Dissection ◽

Breast Cancer Patients ◽

Nodal Involvement ◽

Node Dissection ◽

Axillary Ultrasound

4 Background: Recent reports have indicated a lack of overall survival benefit for axillary node dissection versus sentinel lymph node biopsy in early breast cancer. To study this further, we wished to assess the accuracy and effectiveness of ultrasound guided fine needle aspiration (FNA) cytology in detecting lymph node involvement in breast cancer patients, in order to refine and evaluate our current clinical pathways as newly diagnosed invasive breast cancer patients routinely undergo pre-surgical axillary ultrasound. Methods: An FNA was taken from nodes of consecutive patients, which appeared abnormal on ultrasonography based on size, morphology, fatty hilum and cortical thickness measurements. Ultrasound and FNA cytological findings were correlated with histology following axillary node dissection. Of 260 cases, 123 (47.3%) had metastatic nodal involvement. Of these cases, only 66 (53.7%) were reported as positive on US findings. Results: The overall positive predictive value (PPV) of ultrasound for detecting metastatic nodal involvement measured 0.82, and the negative predictive value (NPV) was 0.60. The sensitivity was 0.54, specificity measured 0.85 and the accuracy was 0.68. The ultrasound morphological nodal features with the greatest correlation with malignancy were absence of a fatty hilum (p=0.003) and an increased cortical thickness (p=0.03). Cases with a metastatic nodal burden density of a least 20% were also more likely to be detected as abnormal on axillary ultrasound. (p=0.009). Conclusions: Axillary ultrasound has a low NPV and negative sonographic results do not exclude node metastases with sufficient sensitivity in most cases, to justify its routine clinical use. [Table: see text]

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The efficacy of axillary ultrasound in the detection of nodal metastasis in breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e21137 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e21137-e21137

Author(s):

Belinda Lee ◽

Adrian K. Lim ◽

Jonathan Krell ◽

Keshthra Satchithananda ◽

Jacqueline S Lewis ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Cortical Thickness ◽

Predictive Value ◽

Clinical Pathways ◽

Axillary Node ◽

Breast Cancer Patients ◽

Nodal Involvement ◽

Axillary Ultrasound

e21137 Background: Recent reports indicate a lack of survival benefit for axillary node dissection (ALND) versus sentinel lymph node biopsy in early breast cancer. To study this further we assessed the accuracy and effectiveness of ultrasound in detecting axillary nodal involvement in breast cancer patients, aimed at refining and evaluating our current clinical pathways as newly diagnosed invasive breast cancer patients routinely undergo pre-surgical axillary ultrasound. Methods: Ultrasound data were collected from consecutive breast cancer cases over 3 years. Images were reviewed by experienced radiologists and made the following assessments on size, morphology, fatty hilum and cortical thickness of the ipsilateral axillary nodes. The findings were correlated with histology outcomes following ALND. Results: 260 cases were included in the analysis, 113 (43.5%) had evidence of metastatic nodal involvement at final histology. Of these, 59/113 (52.2%) reported positive findings on ultrasonography. The overall positive predictive value of ultrasound for detecting metastatic nodal involvement measured 0.70. The negative predictive value was 0.61. The sensitivity was 52%, specificity measured 78% and the accuracy was 65%. The ultrasound morphological lymph node features with the greatest correlation with malignancy were absence of a fatty hilum (p=0.003) and increased cortical thickness (p=0.03). Cases with a metastatic nodal burden density of a least 20% were more likely to report an abnormal axillary ultrasound. (p=0.009). Conclusions: Axillary ultrasound has a low NPV and negative sonographic results do not exclude axillary node metastases with sufficient sensitivity, to justify its routine clinical use. Clinical pathways need to consider an evidence-based approach, focusing on the criteria by which we select breast cancer patients for axillary nodal dissection.

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A further survey of surgical management of the axilla in UK breast cancer patients

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12664192075819 ◽

2010 ◽

Vol 92 (6) ◽

pp. 506-511 ◽

Cited By ~ 10

Author(s):

Ronan W Glynn ◽

Linda Williams ◽

J Michael Dixon

Keyword(s):

Breast Cancer ◽

Surgical Oncology ◽

Axillary Node ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Internal Mammary Nodes ◽

Axillary Node Clearance ◽

Internal Mammary ◽

Neo Adjuvant Chemotherapy ◽

The Uk

INTRODUCTION The aims of this study were to investigate the practice of axillary lymph node management within different units throughout the UK, and to assess changes in practice since our previous survey in 2004. SUBJECTS AND METHODS A structured questionnaire was sent to 350 members of the British Association of Surgical Oncology. RESULTS There were 177 replies from respondents who managed more than 100 patients a year with breast cancer. Of these: 12 did not perform axillary ultrasound at all in their centre; 17 (10%) employed axillary node clearance (ANC) on all patients; 122(69%) performed sentinel node biopsy (SNB) with dual localisation; and 111 respondents had attended the New Start Course. Radioisotope was most frequently injected 2 h or more before operation. Just 13 surgeons were convinced of the value of dissecting internal mammary nodes visualised on a scan. Reasons for not using dual localisation included lack of nuclear medicine facilities, no local ARSAC licence holder, no probe, and no funding. Sixty-six surgeons stated that, if they had an ARSAC licence and could inject the radioactivity in theatre, this would be a major improvement. In addition, 83 (47%) did not perform SLNB in patients receiving neo-adjuvant chemotherapy. CONCLUSIONS Despite significant changes since 2004, substantial variation remains in management of the axilla. A number of surgeons are practicing outwith current guidelines.

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1017 Sentinel Node Biopsy Vs Axillary Node Clearance in Early Breast Cancer

British Journal of Surgery ◽

10.1093/bjs/znab259.216 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Karki ◽

Y Hassen ◽

E Babu ◽

A Chakravorty

Keyword(s):

Breast Cancer ◽

Sentinel Node ◽

Sentinel Node Biopsy ◽

Early Breast Cancer ◽

Axillary Node ◽

Breast Cancer Patients ◽

Node Negative ◽

Node Biopsy ◽

Axillary Node Clearance ◽

Histological Results

Abstract Aim The introduction of sentinel node biopsy (SLNB) in the late 1990s negated the need for axillary node clearance (ANC) in patients demonstrated to have early invasive breast cancer and histologically node-negative disease. However, the latest evidence from large multi-centre randomised trials suggests that patients could be spared this potentially debilitating procedure077. However, these following criteria must be met: Method A retrospective study of the database of breast cancer patients who had ANC between January 2018 to December 2019 in a single institution was undertaken. The histological results of patients who fulfilled the above criteria were analysed. Results Out of 75 patients who had ANC, 2 were excluded due to inadequate data.The average age was 59 (range 34-83).Of the remaining 73 patients, 57 patients (78%) had early breast cancer (T1/2), 11 (19%) of which fulfilled the criteria for sparing of ANC. Of those 11 patients, 8 (73%) had 0 LNs and 3 (27%) had 1 involved lymph node on histological assessment. Conclusions It has been observed that significant morbidity is associated with ANC. A greater subset of patients can benefit from a more sophisticated and evidence-based approach to the management of the axilla in early breast cancer, safely avoiding ANC without compromising survival.

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