title: Preoperative ultrasound staging of the axilla make's peroperative examination of the sentinel node redundant in breast cancer: saving tissue, time and money.
abstract: OBJECTIVE
  To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging?
  
  
  METHODS
  This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller.
  
  
  CONCLUSIONS
  Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general.
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Van Berckelaer
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Manon
authors.initials: M
authors.lastname: Huizing
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Mireille
authors.initials: M
authors.lastname: Van Goethem
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vervaecke
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Papadimitriou
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Verslegers
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Bich X
authors.initials: BX
authors.lastname: Trinh
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Van Dam
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Sevilay
authors.initials: S
authors.lastname: Altintas
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Tim
authors.initials: T
authors.lastname: Van den Wyngaert
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Ivan
authors.initials: I
authors.lastname: Huyghe
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Siozopoulou
authors.affiliation: Multidisciplinary Breast Clinic Antwerpen, Antwerp University Hospital-University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. Electronic address: Wiebren.Tjalma@uza.be.
authors.forename: Wiebren A A
authors.initials: WA
authors.lastname: Tjalma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D011300:Preoperative Care / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000191:economics / Q000379:methods*; D055815:Young Adult
keywords: Axilla; FNAC; Preoperative axillary staging; Sentinel node; Staging; Ultrasound