12/23/2023 0 Comments Axillary sentinel lymph node biopsy![]() ![]() Thus, proceeding to ALND after suspicious US and positive FNAC could lead to overtreatment in this subset of Z0011 patients. They found that ALND did not confer an advantage compared to SLNB in survival nor recurrence, in a subset of T1–2 patients with no palpable adenopathy and 1 or 2 metastatic lymph nodes. However, the utility of axillary US in recently diagnosed breast cancer patients has been questioned in the past few years because of the practice-changing ACOSOG Z0011 trial. It is a relatively low-cost, quick, and well-tolerated procedure associated with minimal morbidity that can evaluate the axillary status pre-operatively, sparing time, and costs of an unnecessary SLNB and helps clinicians to select patients that could benefit from NACT. The addition of fine-needle aspiration cytology (FNAC) or core needle biopsy to the US enhances the specificity of the method and is being used to assist clinical decisions on breast cancer treatment. ![]() Lymph node imaging alone is insufficiently specific to avoid SLNB and proceed directly to ALND therefore, other strategies had to be developed. It is a promising method to identify the sentinel node and to predict lymph node metastasis before surgery, but larger patient data and multicenter cohort trials are required to establish clinical utility. New technologies such as intradermal microbubbles and contrast-enhanced ultrasound are also currently under investigation. It is important to highlight that these methods are expensive and not broadly available. Using diffusion-weighted imaging (DWI) as an advanced technology of MRI can enhance the accuracy of the method in detecting metastatic axillary lymph nodes as demonstrated by Sui et al. They also found that combining the methods can enhance specificity to 97.67% and sensitivity to 83.05%. found PET/CT and MRI to be highly specific methods (93.18% and 93.75%, respectively), although the sensitivity was not as high (81.03% and 68.57%, respectively). įollowing this trend, non-invasive, less invasive, and costly methods to access the axilla have been studied. ![]() More recently, the role of axillary dissection in sentinel node-positive, early breast cancer patients has been questioned by several trials, including Z0011. In the 1990s, the sentinel node biopsy (SLNB) emerged, leading to the same important prognostic information and minimal morbidity, becoming the standard of care in the management of the axilla in clinically node-negative breast cancer patients. Axillary lymph node dissection (ALND) was performed routinely by William Halsted with great morbidity, especially lymphedema and loss of arm function. Axillary lymph node involvement is one important prognostic factor, but the way to access them has modified over the years. ConclusionsĪxillary US coupled with FNAC can sort patients who have a few metastatic nodes at most from those with heavy axillary burden and could be one more tool to initially evaluate patients and define treatment strategies.īreast cancer is the most common malignancy among women all over the world and responsible for almost 500,000 deaths each year. Only 2.7% of the patients with normal axillary US had more than 2 metastatic nodes in the axillary lymph node dissection, against 50% of the patients with suspicious lymph nodes in the US and positive FNAC. The most sensible method was US (0.59 95% CI, 0.50–0.69), and the most specific was US coupled with FNAC (0.97 95% CI, 0.92–0.99). We compared the patient's characteristics using chi-square test, parametrics and non-parametrics statistics according to the variable. We calculated sensitivity, specificity, and accuracy of the methods. This is a cross-sectional study with retrospective data collection of 241 individuals (239 women and 2 men) with unilateral operable breast cancer who were submitted to preoperative axillary assessment by physical exam, US and FNAC if suspicious nodes by imaging. This study evaluated if axillary ultrasound (US) coupled with fine-needle aspiration cytology (FNAC) can accurately predict clinically relevant node metastasis in patients with breast cancer, and thus assist clinical decisions Methods Axillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years. ![]()
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