Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy--clinical experience in 100 patients.

PURPOSE To study the clinical usefulness of ultrasonography (US)-guided core-needle biopsy (CNB) of axillary lymph nodes and the US-depicted abnormalities that may be used to predict nodal metastases. MATERIALS AND METHODS This retrospective study was HIPAA compliant and institutional review board approved; the requirement for informed patient consent was waived. US-guided 14-gauge CNB of abnormal axillary lymph nodes was performed in 100 of 144 patients with primary breast cancer who underwent US assessment of axillary lymph nodes. A biopsy needle with controllable action rather than a traditional throw-type needle was used. US findings were considered suspicious for metastasis if cortical thickening and/or nonhilar blood flow (NHBF) to the lymph node cortex was present. The absence of any discernible fatty hilum was also noted. RESULTS Nodal metastases were documented at CNB in 64 (64%) of the 100 patients. All 36 patients with negative biopsy results underwent subsequent sentinel lymph node biopsy (SLNB), which yielded negative findings in 32 (89%) patients and revealed metastasis in four (11%). All 44 patients who did not undergo CNB because of negative US results subsequently underwent SLNB, which revealed lymph node metastasis in 12 (27%) patients. Cortical thickening was found in 63 (79%) of the total of 80 metastatic nodes, but only a minority (n = 26 [32%]) of the nodes had an absent fatty hilum. NHBF to the cortex was detected in 52 (65%) metastatic nodes. Both absence of a fatty hilum (metastasis detected in 26 [93%] of 28 nodes) and cortical thickening combined with NHBF (metastasis detected in 52 [81%] of 64 nodes) had a high positive predictive value. No clinically important complications were encountered with the biopsy procedures. CONCLUSION Axillary lymph nodes with abnormal US findings can be sampled with high accuracy and without major complications by using a modified 14-gauge CNB technique.

[1]  J. Peterse,et al.  Ultrasonography and Fine-Needle Aspiration Cytology Can Spare Breast Cancer Patients Unnecessary Sentinel Lymph Node Biopsy , 2006, Annals of Surgical Oncology.

[2]  C. Goldsmith,et al.  A Prospective Evaluation of Positron Emission Tomography Scanning, Sentinel Lymph Node Biopsy, and Standard Axillary Dissection for Axillary Staging in Patients with Early Stage Breast Cancer , 2004, Annals of Surgical Oncology.

[3]  L. Goldstein,et al.  Prognostic and predictive factors in early-stage breast cancer. , 2004, The oncologist.

[4]  B. Seifert,et al.  Preoperative breast cancer staging: MR imaging of the axilla with ultrasmall superparamagnetic iron oxide enhancement. , 2002, Radiology.

[5]  S. Yasuda,et al.  Comparative efficacy of positron emission tomography and ultrasonography in preoperative evaluation of axillary lymph node metastases in breast cancer , 2000, Breast cancer.

[6]  R. Foster,et al.  The sentinel node in breast cancer--a multicenter validation study. , 1998, The New England journal of medicine.

[7]  Mousumi Banerjee,et al.  Tree-based model for breast cancer prognostication. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  J. Chang,et al.  Patients with Breast Cancer: Differences in Color Doppler Flow and Gray-Scale US Features of Benign and Malignant Axillary Lymph Nodes , 2000, Radiology.

[9]  E J Feleppa,et al.  In vitro B‐mode ultrasonographic criteria for diagnosing axillary lymph node metastasis of breast cancer. , 1999, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[10]  G. Royle,et al.  Ultrasound detection of axillary lymph node metastases in breast cancer. , 1989, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[11]  A. Y. de Kanter,et al.  Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer , 1999, The British journal of surgery.

[12]  E. Azavedo,et al.  Ultrasound‐guided large needle core biopsy of the axilla , 2004, Acta radiologica.

[13]  U. Topal,et al.  Role of ultrasound-guided core needle biopsy of axillary lymph nodes in the initial staging of breast carcinoma. , 2005, European journal of radiology.

[14]  S. Love,et al.  Level I and II axillary dissection in the treatment of early-stage breast cancer. An analysis of 259 consecutive patients. , 1990, Archives of surgery.

[15]  G. Ott,et al.  Lymphadenopathy: differentiation of benign from malignant disease--color Doppler US assessment of intranodal angioarchitecture. , 1998, Radiology.

[16]  A. Alastrué,et al.  Sentinel node biopsy as a practical alternative to axillary lymph node dissection in breast cancer patients: an approach to its validity. , 2000, Annals of oncology : official journal of the European Society for Medical Oncology.

[17]  S. Pinder,et al.  Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer , 2003, British Journal of Cancer.

[18]  S. Singletary,et al.  Impact of Clinicopathological Factors on Sensitivity of Axillary Ultrasonography in the Detection of Axillary Nodal Metastases in Patients With Breast Cancer , 2003, Annals of Surgical Oncology.

[19]  E. Perez,et al.  Role of axillary node dissection in patients with T1a and T1b breast cancer: Mayo Clinic experience. , 2001, Archives of surgery.

[20]  E. Marussi,et al.  Accuracy of ultrasound and clinical examination in the diagnosis of axillary lymph node metastases in breast cancer. , 1991, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[21]  Y. Ko,et al.  Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. , 1997, AJR. American journal of roentgenology.

[22]  F. Gilbert,et al.  Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes. , 2002, The British journal of radiology.

[23]  A E Giuliano,et al.  Sentinel-lymph-node biopsy for breast cancer--not yet the standard of care. , 1998, The New England journal of medicine.

[24]  Savitri Krishnamurthy,et al.  Role of ultrasound‐guided fine‐needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma , 2002, Cancer.

[25]  In Vitro Sonographic Evaluation of Sentinel Lymph Nodes for Detecting Metastasis in Breast Cancer , 2004, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[26]  L J Schultze Kool,et al.  Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. , 2003, European journal of cancer.

[27]  Mary J. Nissen,et al.  Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer , 2002, Annals of Surgical Oncology.

[28]  M. Wallack,et al.  Retrospective analysis of sentinel node localization in multifocal, multicentric, palpable, or nonpalpable breast cancer. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[29]  J. Vaidya,et al.  Role of ultrasonography to detect axillary node involvement in operable breast cancer. , 1996, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[30]  J. Donohue,et al.  Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer? , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  R. Schmidt,et al.  US-guided core needle biopsy of axillary lymph nodes in patients with breast cancer: why and how to do it. , 2007, Radiographics : a review publication of the Radiological Society of North America, Inc.