Role of Ultrasonography of Regional Nodal Basins in Staging Triple-Negative Breast Cancer and Implications For Local-Regional Treatment.
OBJECTIVE
We sought to determine the rate at which regional nodal ultrasonography would increase the nodal disease stage in patients with triple-negative breast cancer (TNBC) beyond the clinical stage determined by physical examination and mammography alone, and significantly affect the treatments delivered to these patients.


METHODS
We retrospectively reviewed the charts of women with stages I to III TNBC who underwent physical examination, mammography, breast and regional nodal ultrasonography with needle biopsy of abnormal nodes, and definitive local-regional treatment at our institution between 2004 and 2011. The stages of these patients' disease with and without ultrasonography of the regional nodal basins were compared using the Pearson χ(2) test. Definitive treatments of patients whose nodal disease was upstaged on the basis of ultrasonographic findings were compared to those of patients whose disease stage remained the same.


RESULTS
A total of 572 women met the study requirements. In 111 (19.4%) of these patients, regional nodal ultrasonography with needle biopsy resulted in an increase in disease stage from the original stage by physical examination and mammography alone. Significantly higher percentages of patients whose nodal disease was upstaged by ultrasonographic findings compared to that in patients whose disease was not upstaged underwent neoadjuvant systemic therapy (91.9% and 51.2%, respectively; P<.0001), axillary lymph node dissection (99.1% and 34.5%, respectively; P<.0001), and radiation to the regional nodal basins (88.2% and 29.1%, respectively; P<.0001).


CONCLUSIONS
Regional nodal ultrasonography in TNBC frequently changes the initial clinical stage and plays an important role in treatment planning.
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: sfshaitelman@mdanderson.org.
Simona F
SF
Shaitelman
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Welela
W
Tereffe
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Basak E
BE
Dogan
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Kenneth R
KR
Hess
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abigail S
AS
Caudle
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Vicente
V
Valero
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Michael C
MC
Stauder
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Savitri
S
Krishnamurthy
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Rosalind P
RP
Candelaria
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Eric A
EA
Strom
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Wendy A
WA
Woodward
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Kelly K
KK
Hunt
Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Thomas A
TA
Buchholz
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Gary J
GJ
Whitman
D000328:Adult; D000368:Aged; D001365:Axilla / Q000000981:diagnostic imaging; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008327:Mammography; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging / Q000379:methods*; D010808:Physical Examination; D012189:Retrospective Studies; D064726:Triple Negative Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D016217:Ultrasonography, Mammary / Q000379:methods