title: Impact of axillary ultrasound and core needle biopsy on the utility of intraoperative frozen section analysis and treatment decision making in women with invasive breast cancer.
abstract: BACKGROUND
  Our objective was to evaluate the impact of preoperative axillary ultrasound and core needle biopsy (CNB) on breast cancer treatment decision making. A secondary aim was to evaluate the impact on the utility of intraoperative sentinel lymph node (SLN) frozen section.
  
  
  METHODS
  A review of 84 patients with clinically negative axilla who underwent axillary ultrasound was performed. Sensitivity, specificity, and positive/negative predictive value for axillary ultrasound with CNB was calculated.
  
  
  RESULTS
  Thirty-one (37%) had suspicious nodes. Of 27 amenable to CNB, 12 (14%) were malignant, changing treatment plans. The sensitivity of ultrasound and CNB was 54% and specificity 100%; the positive and negative predictive values were 100% and 80%, respectively. In 41 patients with normal ultrasounds who underwent SLN frozen section, 10 (24%) were positive.
  
  
  CONCLUSIONS
  Preoperative axillary ultrasound impacts treatment decision making in 14%. With a sensitivity of 54%, it is a useful adjunct to, but not replacement for, SLN biopsy. Frozen section remains of utility even after a negative axillary ultrasound.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI 53792-7375, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Caretta-Weyer
authors.forename: Gale A
authors.initials: GA
authors.lastname: Sisney
authors.forename: Catherine
authors.initials: C
authors.lastname: Beckman
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Burnside
authors.forename: Lonie R
authors.initials: LR
authors.lastname: Salkowsi
authors.forename: Roberta M
authors.initials: RM
authors.lastname: Strigel
authors.forename: Lee G
authors.initials: LG
authors.lastname: Wilke
authors.forename: Heather B
authors.initials: HB
authors.lastname: Neuman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging; D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007432:Intraoperative Period; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D015412:Mastectomy, Segmental; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor