Researchers in the United Kingdom have shown that the addition of axillary ultrasound prior to initial breast-conserving surgery spared nearly one-third of women with early-stage breast cancer who had underarm (axillary) lymph node metastases from a second breast cancer surgery to remove additional axillary nodes.The study found that axillary ultrasound (AUS) can be useful for detecting large deposits of cancer cells, called macrometastases, in axillary lymph nodes, which can be removed at the same time as initial breast cancer surgery.?Axillary ultrasound combined with needle biopsy for suspicious nodes is a low-cost, accurate and minimally invasive procedure that should be performed routinely before surgery in women with breast cancer, even those with early-stage disease,? said lead author Bedanta Baruah, MD, surgical research fellow in breast cancer at the Cardiff University School of Medicine. ?Routine use of this approach will give oncologists and surgeons an earlier picture of cancer spread to underarm lymph nodes, and help some women avoid the trauma, costs and anxiety associated with a second surgery.?Traditionally, following the identification of a suspicious lump, women undergo a biopsy procedure such as fine-needle aspiration cytology (FNAC) or core needle biopsy to determine if the mass is malignant. Once cancer is confirmed, women are scheduled for breast-conservation surgery to remove the tumor, biopsy the ?sentinel? axillary lymph node (the node to which cancer is most likely to spread), and remove other nodes for examination if the sentinel node is found to contain cancer cells. However, if postsurgical pathological examination of the sentinel node identifies cancer cells that were not found during initial surgery, a patient may have to return for a second surgery to remove additional lymph nodes.Researchers in this study examined an alternative approach: adding AUS at the same time as breast FNAC or core needle biopsy to identify potential macrometastases in axillary lymph nodes before surgery. In 274 women with early-stage breast cancer who were scheduled for surgery, AUS and FNAC analysis of suspicious nodes detected lymph node macrometastases in 29.8% (17) of 57 women with nodal metastases on final pathology. These 17 women proceeded to breast cancer surgery, where the axillary lymph nodes were removed at the same time as lumpectomy, and they were spared from a second surgical procedure.AUS and FNAC had a sensitivity of 29.8% (95% CI: 19.5-42.7), 7 specificity of 100% (95% CI: 98.3-100), positive predictive value of 100% (95% CI: 81.6 -100), negative predictive value of 84.4% (95% CI: 79.5-88.4) and an overall accuracy of 84.4% (95% CI 80.7-89.1). Pre-operative ultrasound was normal in all patients with nodal micro-metastases (n=7).The researchers noted that pre-operative AUS was not able to detect smaller ?micrometastases,? and was unable to detect macrometastases in many cases, suggesting that sentinel node biopsy is still indicated in patients in whom the results of preoperative AUS are normal. “Our results suggest that AUS and FNAC should be performed routinely in early stage breast cancer patients eligible for breast conservation”, Baruah noted.The results of this studies were presented duiring the 2009 (third) Breast Cancer Symposium held from October 8-10, 2009, at the San Francisco Marriott.Reference: B. P. Baruah, A. Goyal, P. Young, A. G. Douglas-Jones, R. E. Mansel, on behalf of Cardiff Breast Unit Should axillary ultrasound and fine-needle aspiration cytology be performed routinely in early breast cancer patients eligible for breast conservation? Presented on Friday, October 9, 2009 by Dr Bedanta P. Baruahat at the American Society of Clinical Oncology (ASCO) 2009 Breast Cancer Symposium.

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