Axillary ultrasound can help avoid sentinel node biopsy surgery


NEW YORK (Reuters Health), Oct 8 - Use of axillary ultrasound combined with fine-needle aspiration cytology (FNAC) can prevent unnecessary sentinel lymph node biopsy in roughly 30% of node-positive, early breast cancer patients, researchers said this week at a press briefing for the 2009 Breast Cancer Symposium in San Francisco.

"Our results suggest that axillary ultrasound and FNAC should be performed routinely in early stage breast cancer patients eligible for breast conservation," Dr. Bedanta P. Baruah and co-researchers from Cardiff University, U.K., concluded in their abstract for the meeting.

Their study involved 274 women scheduled for breast conservation surgery who were evaluated preoperatively with axillary ultrasonography.

FNAC was performed in patients with suspicious nodes. Axillary clearance was performed in FNAC-positive cases, while sentinel node biopsy was performed in other cases.

Nearly 21% of patients (57 of 274) had proven nodal macro-metastases. Axillary ultrasound and FNAC accurately identified 29.8% of these patients (17 of 57), thereby preventing an unnecessary sentinel node biopsy. Other performance parameters included a specificity of 100%, positive predictive value of 100%, and a negative predictive value of 84.4%.

Although axillary ultrasound and FNAC were highly accurate (84.4%) in detecting nodal macro-metastases, they failed to detect all seven cases of nodal micro-metastases.

No significant learning curve was required to effectively use axillary ultrasound plus FNAC, the researchers note.

"Axillary ultrasound with FNAC is a safe outpatient procedure, which can save many patients with axillary metastases from an unnecessary sentinel node biopsy and a second operation," Dr. Baruah said.

By Anthony J. Brown, M.D.

Last Updated: 2009-10-07 17:21:08 -0400 (Reuters Health)

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