title: Axillary ultrasound examination is useful for selecting patients optimally suited for sentinel lymph node biopsy after primary systemic chemotherapy.
abstract: BACKGROUND
  Controversy surrounds the reliability of sentinel lymph node biopsy after primary systemic chemotherapy. In this study, we assessed axillary ultrasound for selecting patients most likely to optimally benefit from biopsy.
  
  
  METHODS
  The study included 87 patients who received primary systemic chemotherapy and underwent a sentinel lymph node biopsy followed by axillary lymph node dissection. Lymph nodes >10 mm in diameter, irregularly swollen, round, and homogeneously hypoechoic without an echo-rich center were considered axillary ultrasound positive.
  
  
  RESULTS
  In axillary ultrasound-negative patients before and after primary systemic chemotherapy, identification, sensitivity, and false-negative rates were 81%, 100%, and 0%, respectively. However, in patients whose lymph nodes converted from positive to negative after primary systemic chemotherapy, these values were 83%, 70.8%, and 29.2%, respectively.
  
  
  CONCLUSIONS
  Axillary ultrasound-negative patients before and after primary systemic chemotherapy were suitable for sentinel lymph node biopsy. Axillary ultrasound should be used during primary systemic chemotherapy and before surgery.
authors.affiliation: Department of Breast Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shigekawa
authors.forename: Ikuko
authors.initials: I
authors.lastname: Sugitani
authors.forename: Hideki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Misono
authors.initials: M
authors.lastname: Misumi
authors.forename: Noriko
authors.initials: N
authors.lastname: Nakamiya
authors.forename: Michiko
authors.initials: M
authors.lastname: Sugiyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sano
authors.forename: Kazuo
authors.initials: K
authors.lastname: Matsuura
authors.forename: Takao
authors.initials: T
authors.lastname: Takahashi
authors.forename: Nobuko
authors.initials: N
authors.lastname: Fujiuchi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Osaki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saeki
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007564:Japan; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D014463:Ultrasonography