title: The role of ultrasound guided core biopsy of axillary nodes in predicting macrometastases and avoiding overtreatment outside ACOSOG Z0011 parameters.
abstract: BACKGROUND
  Z0011 study suggests patients with minimal disease do not require axillary clearance. Exclusions include T3 tumours, mastectomy or neoadjuvant treatment. This study assessed the utility of pre-operative US-guided core biopsy of axillary nodes and its correlation with nodal macrometastases.
  
  
  METHODS
  247 women with breast cancer outside Z0011 criteria were reviewed retrospectively. Sensitivity and specificity of pre-operative axillary ultrasound and core biopsy compared to final histology was assessed by contingency tables.
  
  
  RESULTS
  75/247 patients had macrometastases. Ultrasound-axilla was 72% sensitive and 77% specific in predicting macrometastasis. The positive (PPV) and negative predictive value (NPV) was 58% and 86.4% respectively. Core-biopsy of axilla node, was 92.6% sensitive and 66.7% specific in detecting macrometastasis. PPV and NPV 79.4% and 86.7% respectively.
  
  
  CONCLUSIONS
  Positive pre-operative ultrasound-guided core biopsy accurately predicts macroscopic involvement of axillary nodes. Selected patients outside Z0011 parameters can proceed to axillary clearance without sentinel node biopsy or risking overtreatment.
authors.affiliation: Breast Centre North West, Letterkenny Hospital, Donegal Clinical Research Academy, Galway University Hospitals, Ireland.
authors.forename: Jacqueline Ting
authors.initials: JT
authors.lastname: Y L
authors.affiliation: Breast Centre North West, Letterkenny Hospital, Donegal Clinical Research Academy, Galway University Hospitals, Ireland.
authors.forename: Katherine
authors.initials: K
authors.lastname: McGowan
authors.affiliation: National University of Ireland, Ireland.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Cooley
authors.affiliation: National University of Ireland, Ireland.
authors.forename: Ray
authors.initials: R
authors.lastname: McLaughlin
authors.affiliation: Breast Centre North West, Letterkenny Hospital, Donegal Clinical Research Academy, Galway University Hospitals, Ireland. Electronic address: michael.sugrue@hse.ie.
authors.forename: Michael
authors.initials: M
authors.lastname: Sugrue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D018084:Ultrasonography, Interventional
keywords: Axillary clearance; Breast cancer; Sentinel Node; Ultrasound guided axillary core biopsy