title: Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer.
abstract: The aim of this study was to see how effective ultrasound-guided needle biopsy was at detecting lymph node involvement in patients with early breast cancer. Patients with newly diagnosed invasive breast cancer underwent axillary ultrasound (US) where lymph node size and morphology were noted. A core biopsy (CB) was undertaken of any node greater than 5 mm in longitudinal section. Patients with benign CBs proceeded to sentinel lymph node (SLN) biopsy, whereas those with malignancy underwent axillary lymph node dissection (ALND). US and CB findings were correlated with final surgical histology in all cases. One hundred and thirty-nine patients were examined, of whom 52.5% had lymph node metastases on final histology. One hundred and twenty-one patients (87%) underwent axillary node CB. The overall sensitivity of CB for detecting lymph node metastases was 53.4% (60.3% for macrometastases; 26.7% for micrometastases). The US morphological characteristics most strongly associated with malignancy were absence of a hilum and a cortical thickness greater than 4 mm. However, one third of patients with normal lymph node morphology had nodal metastases, and only 12% of these were diagnosed on CB. CB of axillary lymph nodes can diagnose a substantial number of patients with lymph node metastases, allowing these patients to proceed directly to ALND, avoiding unnecessary SLN biopsy.
authors.affiliation: Department of Radiology Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK. peter.britton@addenbrookes.nhs.uk
authors.forename: P D
authors.initials: PD
authors.lastname: Britton
authors.forename: A
authors.initials: A
authors.lastname: Goud
authors.forename: S
authors.initials: S
authors.lastname: Godward
authors.forename: S
authors.initials: S
authors.lastname: Barter
authors.forename: A
authors.initials: A
authors.lastname: Freeman
authors.forename: M
authors.initials: M
authors.lastname: Gaskarth
authors.forename: P
authors.initials: P
authors.lastname: Rajan
authors.forename: R
authors.initials: R
authors.lastname: Sinnatamby
authors.forename: J
authors.initials: J
authors.lastname: Slattery
authors.forename: E
authors.initials: E
authors.lastname: Provenzano
authors.forename: M
authors.initials: M
authors.lastname: O'Donovan
authors.forename: S
authors.initials: S
authors.lastname: Pinder
authors.forename: J R
authors.initials: JR
authors.lastname: Benson
authors.forename: P
authors.initials: P
authors.lastname: Forouhi
authors.forename: G C
authors.initials: GC
authors.lastname: Wishart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014463:Ultrasonography
references.citation: Radiology. 2004 Feb;230(2):543-52
references.pmid: 14699178
references.citation: Radiology. 2004 Mar;230(3):727-34
references.pmid: 14990839
references.citation: Eur J Cancer. 2003 May;39(8):1068-73
references.pmid: 12736105
references.citation: Radiology. 2002 Nov;225(2):527-36
references.pmid: 12409591
references.citation: Ann Surg Oncol. 2006 Jan;13(1):31-5
references.pmid: 16372147
references.citation: World J Surg. 1997 Mar-Apr;21(3):270-4
references.pmid: 9015169
references.citation: Br J Cancer. 2003 Oct 6;89(7):1310-3
references.pmid: 14520465
references.citation: AJR Am J Roentgenol. 2001 Apr;176(4):1069-74
references.pmid: 11264113
references.citation: J Clin Oncol. 2005 Oct 20;23(30):7703-20
references.pmid: 16157938
references.citation: Cancer. 1983 Nov 1;52(9):1551-7
references.pmid: 6352003
references.citation: Breast Cancer Res Treat. 2006 Sep;99(2):203-8
references.pmid: 16541308
references.citation: Eur J Radiol. 2005 Dec;56(3):382-5
references.pmid: 16024205
references.citation: Radiology. 1997 Dec;205(3):831-5
references.pmid: 9393544
references.citation: Br J Surg. 1999 Nov;86(11):1459-62
references.pmid: 10583296
references.citation: Cancer. 2005 Jan 15;103(2):358-67
references.pmid: 15593354
references.citation: Eur J Cancer. 2003 Jan;39(2):170-4
references.pmid: 12509948
references.citation: Radiology. 1992 Apr;183(1):215-20
references.pmid: 1549675
references.citation: Lancet Oncol. 2007 Oct;8(10):881-8
references.pmid: 17851130
references.citation: Eur J Surg Oncol. 2001 Mar;27(2):141-5
references.pmid: 11289748
references.citation: Cancer. 2002 Sep 1;95(5):982-8
references.pmid: 12209680
references.citation: Br J Cancer. 2003 Mar 10;88(5):702-6
references.pmid: 12618878
references.citation: Eur J Cancer. 2003 May;39(8):1037-8
references.pmid: 12736100
references.citation: Lancet Oncol. 2006 Dec;7(12):983-90
references.pmid: 17138219
references.citation: Can Assoc Radiol J. 2005 Dec;56(5):289-96
references.pmid: 16579022
references.citation: Eur Radiol. 2006 Oct;16(10):2153-60
references.pmid: 16670863