1
|
Chen I, Kitich A, Joines M, Sayre J, Dascalos J, Hoyt A, Milch H. To scan or not to scan: effect of scanning the axilla of all patients undergoing diagnostic breast ultrasound. Clin Imaging 2023; 99:33-37. [PMID: 37060679 DOI: 10.1016/j.clinimag.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Breast ultrasonography is a useful modality in patients undergoing diagnostic and screening breast imaging. However, breast ultrasound has a high false positive rate and can be time-consuming to perform. PURPOSE The purpose of this study was to evaluate the clinical impact of incidental axillary findings found on diagnostic breast ultrasounds at a single multi-site institution that has a standard protocol of scanning the axilla for all breast ultrasound exams. METHODS All diagnostic breast ultrasounds were retrospectively reviewed from January 2017 to September 2019. Follow-up imaging, relevant clinical history, and pathology results were also reviewed. All positive axillary findings were divided into incidental or non-incidental findings depending on whether there was a direct clinical indication to scan the axilla. Descriptive statistics were performed with a 5% level of significance. RESULTS Of the 19,695 diagnostic ultrasounds performed during this timeframe, there were 91 (0.5%) incidental axillary findings given a BIRADS category 3 or 4, and none of these findings resulted in the diagnosis of an occult breast cancer. One biopsy-proven SLL/CLL lymphoma was diagnosed that was otherwise clinically occult. CONCLUSION Routine axillary scanning in all patients undergoing a diagnostic breast ultrasound at a large multi-site institution yields a low rate of incidental findings and has minimal impact on detection of cancer.
Collapse
Affiliation(s)
- Iris Chen
- Department of Radiology, David Geffen School of Medicine at UCLA, California, USA.
| | - Aleksandar Kitich
- Department of Radiology, David Geffen School of Medicine at UCLA, California, USA
| | - Melissa Joines
- Department of Radiology, David Geffen School of Medicine at UCLA, California, USA.
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine at UCLA, California, USA.
| | - Jane Dascalos
- Department of Radiology, David Geffen School of Medicine at UCLA, California, USA.
| | - Anne Hoyt
- Department of Radiology, David Geffen School of Medicine at UCLA, California, USA.
| | - Hannah Milch
- Department of Radiology, David Geffen School of Medicine at UCLA, California, USA.
| |
Collapse
|
2
|
Jazrawi A, Pantiora E, Abdsaleh S, Bacovia DV, Eriksson S, Leonhardt H, Wärnberg F, Karakatsanis A. Magnetic-Guided Axillary UltraSound (MagUS) Sentinel Lymph Node Biopsy and Mapping in Patients with Early Breast Cancer. A Phase 2, Single-Arm Prospective Clinical Trial. Cancers (Basel) 2021; 13:cancers13174285. [PMID: 34503095 PMCID: PMC8428333 DOI: 10.3390/cancers13174285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 01/23/2023] Open
Abstract
Lymph Node Dissection (SLND) is standard of care for diagnosing sentinel lymph node (SLN) status in patients with early breast cancer. Study aim was to determine whether the combination of Superparamagnetic iron oxide nanoparticles (SPIO) MRI-lymphography (MRI-LG) and a Magnetic-guided Axillary UltraSound (MagUS) with biopsy can allow for minimally invasive, axillary evaluation to de-escalate surgery. Patients were injected with 2 mL of SPIO and underwent MRI-LG for SN mapping. Thereafter MagUS and core needle biopsy (CNB) were performed. Patients planned for neoadjuvant treatment, the SLN was clipped and SLND was performed after neoadjuvant with the addition of isotope. During surgery, SLNs were controlled for signs of previous biopsy or clip. The primary endpoint was MagUS SLN detection rate, defined as successful SLN detection of at least one SLN of those retrieved in SLND. In 79 patients, 48 underwent upfront surgery, 12 received neoadjuvant and 19 had recurrent cancer. MagUS traced the SLN in all upfront and neoadjuvant cases, detecting all patients with macrometastases (n = 10). MagUS missed only one micrometastasis, outperforming baseline axillary ultrasound AUS (AUC: 0.950 vs. 0.508, p < 0.001) and showing no discordance to SLND (p = 1.000). MagUS provides the niche for minimally invasive axillary mapping that can reduce diagnostic surgery.
Collapse
Affiliation(s)
- Allan Jazrawi
- Centre for Clinical Research, County Västmanland, Uppsala University, 72189 Västerås, Sweden; (A.J.); (S.E.)
- Department of Surgery, Västmanlands County Hospital, 72189 Västerås, Sweden
| | - Eirini Pantiora
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden; (E.P.); (S.A.); (F.W.)
- Department of Surgery, Section for Endocrine and Breast Surgery, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Shahin Abdsaleh
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden; (E.P.); (S.A.); (F.W.)
- Aleris Mammography Unit, 75320 Uppsala, Sweden
| | - Daniel Vasiliu Bacovia
- Department Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden;
| | - Staffan Eriksson
- Centre for Clinical Research, County Västmanland, Uppsala University, 72189 Västerås, Sweden; (A.J.); (S.E.)
- Department of Surgery, Västmanlands County Hospital, 72189 Västerås, Sweden
| | - Henrik Leonhardt
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41343 Gothenburg, Sweden;
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden; (E.P.); (S.A.); (F.W.)
- Department of Surgery, Section for Endocrine and Breast Surgery, Uppsala University Hospital, 75185 Uppsala, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Andreas Karakatsanis
- Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden; (E.P.); (S.A.); (F.W.)
- Department of Surgery, Section for Endocrine and Breast Surgery, Uppsala University Hospital, 75185 Uppsala, Sweden
- Correspondence:
| |
Collapse
|
3
|
Sun J, Mathias BJ, Laronga C, Sun W, Zhou JM, Fulp WJ, Kiluk JV, Lee MC. Impact of Axillary Dissection Among Patients With Sentinel Node-Positive Breast Cancer Undergoing Mastectomy. J Natl Compr Canc Netw 2021; 19:40-47. [PMID: 33406495 DOI: 10.6004/jnccn.2020.7597] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial supports omission of completion axillary lymph node dissection (CLND) after breast-conservation surgery with a positive sentinel lymph node biopsy (SLNB). We hypothesized that CLND also does not impact outcomes in women with clinically node-negative (cN0), pathologically node-positive breast cancer undergoing mastectomy. MATERIALS AND METHODS A single-institution retrospective review was performed of patients with SLN-positive breast cancer treated from July 1999 through May 2018. Clinicopathologic and outcome data were collected. Patients with SLNBs were compared with those receiving SLNB and CLND. The Kruskal-Wallis, chi-square, and Fisher exact tests were used to assess for differences between continuous and categorical variables. The log-rank test was used for time-to-event analyses, and Cox proportional hazards models were fit for locoregional and distant recurrence and overall survival (OS). RESULTS Of 329 patients with SLN-positive breast cancer undergoing mastectomy, 60% had CLND (n=201). Median age at diagnosis was 53 years (interquartile range [IQR], 46-62 years). The median number of SLNs sampled was 3 (IQR, 2-4), and the median number of positive SLNs was 1 (IQR, 1-2). Patients receiving CLND had higher tumor grades (P=.02) and a higher proportion of hormone receptor negativity (estrogen receptor, 19%; progesterone receptor, 27%; both P=.007). A total of 44 patients (22%) had increased N stage after CLND. Median follow-up was 51 months (IQR, 29-83 months). No association was found between CLND and change in OS and locoregional or distant recurrence. Completion of postmastectomy radiotherapy was associated with improved OS (P=.04). CONCLUSIONS CLND is not significantly correlated with reduced recurrence or improved OS among patients who have cN0, SLN-positive breast cancer treated with mastectomy. CLND was significantly correlated with receipt of adjuvant systemic therapy. Completion of postmastectomy radiotherapy was associated with improved OS.
Collapse
Affiliation(s)
- James Sun
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Brittany J Mathias
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida.,Now with Mercy Clinic Breast Surgery - Coletta, Oklahoma City, Oklahoma
| | - Christine Laronga
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Weihong Sun
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jun-Min Zhou
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida; and
| | - William J Fulp
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida; and.,Now with Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John V Kiluk
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - M Catherine Lee
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| |
Collapse
|
4
|
Caudle AS, Kuerer HM, Krishnamurthy S, Shin K, Hobbs BP, Ma J, Mittendorf EA, Washington AC, DeSnyder SM, Black DM, Hunt KK, Yang WT. Feasibility of fine-needle aspiration for assessing responses to chemotherapy in metastatic nodes marked with clips in breast cancer: A prospective registry study. Cancer 2018; 125:365-373. [PMID: 30359480 DOI: 10.1002/cncr.31825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/13/2018] [Accepted: 10/01/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clips are often placed to mark axillary nodes with biopsy-confirmed metastases in patients with breast cancer. The evaluation of clipped nodes after chemotherapy can identify patients who have eradication of nodal disease. The goal of this study was to determine whether preoperative fine-needle aspiration (FNA) of clipped nodes after neoadjuvant chemotherapy (NAC) could predict the presence of residual disease. METHODS This prospective registry study enrolled 50 patients with a clip placed to mark nodes with biopsy-confirmed metastases who had completed NAC. Participants underwent FNA of the clipped node before seed-localized lymph node excision. FNA pathology was compared with surgical pathology. RESULTS There were 36 patients (72%) with residual disease on surgical pathology: 3 (8%) had a nondiagnostic aspirate, carcinoma was seen in 14 (39%), and 19 (53%) had a false-negative result. The sensitivity of FNA was 42.4%, its specificity was 100%, and its negative predictive value was 40.6%. In a univariate analysis, the odds of a true-positive result increased significantly with the mean initial size of the clipped node (odds ratio [OR], 4.3; P = .004) and the size of the metastatic focus after NAC (OR, 1.3; P = 0.003), whereas normalization of nodes after chemotherapy (OR, 0.1) and a lack of response on ultrasound (OR, 0.11) were associated with a false-negative result (P = .01). CONCLUSIONS FNA of marked nodes after chemotherapy has a high false-negative rate. This highlights the need for surgical staging of the axilla after NAC to assess the response.
Collapse
Affiliation(s)
- Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Savitri Krishnamurthy
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kyungmin Shin
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Junsheng Ma
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth A Mittendorf
- Department of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Ashley C Washington
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dalliah M Black
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei T Yang
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
5
|
Reyna C, Kiluk JV, Frelick A, Khakpour N, Laronga C, Lee MC. Impact of axillary ultrasound (AUS) on axillary dissection in breast conserving surgery (BCS). J Surg Oncol 2015; 111:813-8. [DOI: 10.1002/jso.23885] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/24/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Chantal Reyna
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - John V. Kiluk
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Anne Frelick
- University of South Florida; Morsani College of Medicine; Tampa Florida
| | - Nazanin Khakpour
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Christine Laronga
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Marie Catherine Lee
- Comprehensive Breast Program; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| |
Collapse
|
6
|
Farrell TPJ, Adams NC, Stenson M, Carroll PA, Griffin M, Connolly EM, O’Keeffe SA. The Z0011 Trial: Is this the end of axillary ultrasound in the pre-operative assessment of breast cancer patients? Eur Radiol 2015; 25:2682-7. [DOI: 10.1007/s00330-015-3683-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/05/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
|
7
|
Gilani SM, Fathallah L, Al-Khafaji BM. Preoperative fine needle aspiration of axillary lymph nodes in breast cancer: clinical utility, diagnostic accuracy and potential pitfalls. Acta Cytol 2014; 58:248-54. [PMID: 24923670 DOI: 10.1159/000362682] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/04/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study evaluates the diagnostic accuracy of axillary lymph node fine needle aspiration (FNA) cytology in breast cancer and correlates it with clinical parameters/outcomes. STUDY DESIGN A total of 91 females underwent FNA of axillary lymph nodes at our institution from January 2007 to February 2013. The cases were classified as 'positive', 'negative for malignancy' and 'nondiagnostic'. RESULTS Forty-six cases (50.5%) had a histologic follow-up (4.4 ± 3.1 months); of these, 22 (47.8%) were true positive, 7 (15.2%) were true negative, 2 (4.3%) were false negative, 5 (11%) were false positive and 10 (21.7%) were nondiagnostic. However, cytological review of all false positive and false negative cases confirmed the presence or absence of tumor, respectively. All false positive cases had undergone preoperative neoadjuvant chemotherapy, with no residual tumor present, and a treatment effect identified only histologically. Meanwhile, the 2 false negative cases involved micrometastasis (≤ 1.5 mm). Thus, if we exclude these false positive cases (complete responders), then the sensitivity, specificity, positive predictive value and negative predictive value were 91.7, 100, 100 and 77.8%, respectively. All preoperative FNA-positive axillary lymph nodes were spared from sentinel lymph node biopsy except for 3 of 27 (11.1%). CONCLUSION We suggest that axillary lymph node FNA is a highly sensitive technique with a low false negative rate (4.3%) and a diagnostic accuracy of 93.5%.
Collapse
Affiliation(s)
- Syed M Gilani
- Department of Pathology, St. John Hospital and Medical Center, Detroit, Mich., USA
| | | | | |
Collapse
|
8
|
Fornage BD. Local and regional staging of invasive breast cancer with sonography: 25 years of practice at MD Anderson Cancer Center. Oncologist 2013; 19:5-15. [PMID: 24309983 DOI: 10.1634/theoncologist.2013-0323] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
At The University of Texas MD Anderson Cancer Center, we have used sonography (US) extensively for more than 2 decades to refine the local and regional staging of invasive breast cancer. Although magnetic resonance imaging is superior to all other imaging modalities in the measurement of the primary tumor and detection of additional foci of malignancy, in our experience US has shown sufficient accuracy in clinical practice to stage most invasive breast cancers. The exceptions are ill-defined tumors such as invasive lobular cancers and tumors in breasts containing extensive diffuse benign disease. An advantage of US is that multifocality or multicentricity can be confirmed via US-guided fine-needle aspiration within 15 minutes and the information shared immediately with the patient and the breast surgeon or medical oncologist. US has also proved indispensable in the evaluation of lymphatic spread because it can evaluate more nodal basins (e.g., the supraclavicular fossa and low neck) than magnetic resonance imaging can and because it can guide needle biopsy to confirm the status of any indeterminate node (including internal mammary nodes) within minutes.
Collapse
Affiliation(s)
- Bruno D Fornage
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
9
|
Schipper R, van Roozendaal L, de Vries B, Pijnappel R, Beets-Tan R, Lobbes M, Smidt M. Axillary ultrasound for preoperative nodal staging in breast cancer patients: Is it of added value? Breast 2013; 22:1108-13. [DOI: 10.1016/j.breast.2013.09.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/03/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022] Open
|
10
|
Indications for Axillary Ultrasound Use in Breast Cancer Patients. Clin Breast Cancer 2012; 12:433-7. [DOI: 10.1016/j.clbc.2012.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 08/31/2012] [Accepted: 09/13/2012] [Indexed: 11/17/2022]
|
11
|
Lee MC, Joh JE, Chau A. Axillary Staging Prior to Neoadjuvant Chemotherapy: The Roles of Sentinel Lymph Node Biopsy and Axillary Ultrasonography. Cancer Control 2012; 19:277-285. [DOI: 10.1177/107327481201900404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Marie Catherine Lee
- Comprehensive Breast Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Division of Oncologic Sciences at the University of South Florida, Tampa, Florida
| | - Jennifer E. Joh
- Comprehensive Breast Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Hoffberger Breast Center at Mercy, Mercy Medical Center, Baltimore, Maryland
| | - Alec Chau
- Diagnostic Imaging Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Division of Oncologic Sciences at the University of South Florida, Tampa, Florida
| |
Collapse
|
12
|
George R. Re: selective application of routine preoperative axillary ultrasonography reduces costs for invasive breast cancers. Oncologist 2012; 16:1069. [PMID: 21873581 DOI: 10.1634/theoncologist.2011-0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ralph George
- Division of General Surgery, St. Michael’s Hospital, CIBC Breast Centre, Toronto, Canada.
| |
Collapse
|