Ultrasound-Guided Core Biopsy: An Effective Method of Detecting Axillary Nodal Metastases

• Published in: Journal of the American College of Surgeons Vol. 214; no. 1; pp. 12 - 17
• Main Authors: Solon, Jacqueline G., MB, MRCSI, Power, Colm, MCh, FRCSI, Al-Azawi, Dhafir, MD, FRCSI, Duke, Deirdre, FFR-RCSI, Hill, Arnold D.K., MCh, FRCSI
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2012; Elsevier
• Subjects: Axilla; Biological and medical sciences; Biopsy, Needle - methods; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Female; General aspects; Humans; Lymphatic Metastasis - pathology; Medical sciences; Retrospective Studies; Surgery; Tumors; Ultrasonography, Interventional; Ultrasonography, Mammary; axillary ultrasound-guided core biopsy; AX US-FNAC; Ax US-CB; sentinel lymph node biopsy; lymphovascular invasion; EORTC AMAROS; SNLB; European Organization for Research and Treatment of Cancer After Mapping of the Axilla: Radiotherapy Or Surgery (AMAROS) trial; axillary lymph node dissection; LVI; ALND; axillary ultrasound-guided fine needle aspiration cytology; Lymph node; Methodology; Malignant tumor; Metastasis; Method; Guidance; Medicine; Anatomic pathology; Treatment; Biopsy; Efficiency; Surgery; Ultrasound; Cancer; Axillary
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2011.09.024

Background Axillary nodal status is an important prognostic predictor in patients with breast cancer. This study evaluated the sensitivity and specificity of ultrasound-guided core biopsy (Ax US-CB) at detecting axillary nodal metastases in patients with primary breast cancer, thereby determining how often sentinel lymph node biopsy could be avoided in node positive patients. Study Design Records of patients presenting to a breast unit between January 2007 and June 2010 were reviewed retrospectively. Patients who underwent axillary ultrasonography with or without preoperative core biopsy were identified. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography and percutaneous biopsy were evaluated. Results Records of 718 patients were reviewed, with 445 fulfilling inclusion criteria. Forty-seven percent (n = 210/445) had nodal metastases, with 110 detected by Ax US-CB (sensitivity 52.4%, specificity 100%, positive predictive value 100%, negative predictive value 70.1%). Axillary ultrasonography without biopsy had sensitivity and specificity of 54.3% and 97%, respectively. Lymphovascular invasion was an independent predictor of nodal metastases (sensitivity 60.8%, specificity 80%). Ultrasound-guided core biopsy detected more than half of all nodal metastases, sparing more than one-quarter of all breast cancer patients an unnecessary sentinel lymph node biopsy. Conclusions Axillary ultrasonography, when combined with core biopsy, is a valuable component of the management of patients with primary breast cancer. Its ability to definitively identify nodal metastases before surgical intervention can greatly facilitate a patient's preoperative integrated treatment plan. In this regard, we believe our study adds considerably to the increasing data, which indicate the benefit of Ax US-CB in the preoperative detection of nodal metastases.