Axillary Lymph Node Burden in Invasive Breast Cancer: A Comparison of the Predictive Value of Ultrasound-Guided Needle Biopsy and Sentinel Lymph Node Biopsy.
BACKGROUND
Recent studies suggest that axillary lymph node dissection (ALND) may be omitted in select breast cancer patients with a positive sentinel lymph node biopsy (SLNB). As we trend away from ALND, we must understand the burden of axillary disease among various patient subgroups. For patients with positive nodes determined using ultrasound-guided needle biopsy (USNB), there are no data regarding the extent of axillary disease.


METHODS
An institutional breast cancer registry was retrospectively reviewed to identify women with invasive cancer and a positive USNB/SLNB who had completion ALND. For statistical analysis, we used χ(2) and 1-way analysis of variance.


RESULTS
One hundred ninety-nine USNB-positive (USNB(+)) patients and 434 SLNB(+) patients were eligible for the study. Positive USNB patients were significantly older, had larger tumors, and were more likely to be estrogen receptor-negative/progesterone receptor-negative and HER2/neu(+) than SLNB(+) patients. USNB(+) patients had much higher rates of N2 (33.2% vs. 12.4%; P < .05) and N3 (17.1% vs. 3.9%; P < .05) disease compared with SLNB(+) patients. Higher axillary disease burden was demonstrated in USNB patients who were clinically node negative and those who met Z11 criteria.


CONCLUSIONS
Patients with invasive breast cancer with a positive node on USNB have a significantly greater burden of axillary disease compared with patients with a positive SLNB. USNB(+) patients represent a distinct patient population and further research is required to determine if these patients can be safely exempted from axillary dissection.
Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
Brian A
BA
Boone
Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
Cindy
C
Huynh
Department of Radiology, University of Pittsburgh, Pittsburgh, PA.
Marion L
ML
Spangler
Department of Radiology, University of Pittsburgh, Pittsburgh, PA.
Jules
J
Sumkin
Department of Radiology, University of Pittsburgh, Pittsburgh, PA.
Ronald
R
Johnson
Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
Kandace P
KP
McGuire
Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
Atilla
A
Soran
Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Electronic address: ahregm@mail.magee.edu.
Gretchen M
GM
Ahrendt
D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy
Axillary lymph node dissection; Axillary ultrasound; Lymph node disease; Ultrasound-guided lymph node biopsy; Z0011