The Current Status of Ultrasonography and Fine-Needle Aspiration Citology for the Management of the Axilla in Breast Cancer

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Gustavo Febles De León Andrés Dell´Acqua Andrea Cristiani

Abstract

Objetive: to analyze whether ultrasonography with fine-needle aspiration cytology of an axillary suspicious node, in patients with breast cancer, could help to differentiate between patients with low involvement of the axilla (up to 2 nodes with macrometastasis) of those with high involvement of the axilla (more than 2 lymph nodes with macrometastasis).


Material and methods: A total of 115 consecutive patients with breast cancer (up to 5 cm in diameter), with clinically negative axilla and pathologically positive axilla. All patients underwent preoperative axillary ultrasound and ultrasound-guided fine-needle aspiration cytology was performed in patients with suspicious nodes. In all patients with positive cytology, lymphadenectomy was performed. In all patients with negative ultrasound and cytology, sentinel lymph node biopsy was performed, and when it was positive, lymphadenectomy was performed. The number of pathological lymph nodes was evaluated after lymphadenectomy.


Results: A total of 61 patients had positive axillary ultrasound and cytology. In 42 of them (69%), there were more than 2 pathological lymph nodes. There were 54 patients with negative axillary ultrasound and cytology. In 49 of them (90%), there were only 1 or 2 pathological lymph nodes. Axillary ultrasound and fine-needle aspiration cytology were able to identify 42 of the 47 patients (89%) with more than 2 pathological lymph nodes.


Conclusion: ultrasound and ultrasound-guided fine-needle aspiration citology was able to identify, in a preoperative stage, those patients with high axillary involvement (more than 2 lymph nodes with macrometastasis). The latter are the patients who would benefit from lymphadenectomy of the axilla, ignoring the sentinel lymph node biopsy stage.

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How to Cite
FEBLES DE LEÓN, Gustavo; DELL´ACQUA, Andrés; CRISTIANI, Andrea. The Current Status of Ultrasonography and Fine-Needle Aspiration Citology for the Management of the Axilla in Breast Cancer. Medical Research Archives, [S.l.], v. 11, n. 5, may 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3851>. Date accessed: 03 oct. 2024. doi: https://doi.org/10.18103/mra.v11i5.3851.
Section
Research Articles

References

1.- Veronessi U, Paganelli G, Viale G, Path F, Luini A, Zurrida S, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349:546-553.
2.- Veronessi U, Viale G, Path F, Paganelli G, Zurrida S, Luini A, et al. Sentinel lymph node biopsy in breast cancer: Ten- year results of a randomized controlled study. Ann Surg. 2010;251:595-600.
3.-Febles G, Dell’Acqua A, Cristiani A. Evaluación clínica, ecográfica y citológica de la axila en el cáncer de mama. Rev Senol Patol Mamar. 2016;29:57-62.
4.- Febles G, Dell’Acqua A, Cristiani A, Balbiani C, Bergeret F: Rol de la ecografía y punción con aguja fina en el manejo de la axila en pacientes con cáncer mamario, en la era posterior al ACOSOG Z0011. Rev Senol Patol Mamar. 2018;31(4):123-128.
5.- Bonnema J, van Geel A, Ooijen B, Mali S, Tijam S, Henzen Logmans S, et al. Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: New diagnostic method. World J Surg. 1997;21:270-274.
6. Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortés J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: A systematic review. Am J Roentgenol. 2006;186:1342-1348.
7. Park S, Kim M, Park B. Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol. 2011;18:738-44.
8. Rattay T, Muttalib M, Khalifa E, Duncan A, Parker S. Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy. Breast. 2012;21:210-214.
9.- Giuliano A, Hunt K, Ballman K, Beitsch P, Whitworth P, Blumencranz P, et al. Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial. JAMA. 2011;305: 569-575.
10.- Giuliano A, Ballman K, Mc Call L, Beitsch P, Whitworth P, Blumencranz P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial. Ann.Surg. 2016;264: 413-420.
11.- Black D. Axillary Ultrasound: For All, for None, to Diagnose Positive Nodes, or to Support Avoiding Sentinel Lymph Node Biopsy Altogether. Ann Surg Oncol. 2017;24(1):64–69.
12.- Pilewskie M, Jochelson M, Gooch J, Patil S, Stempel M, Morrow M. Is. preoperative axillary imaging beneficial in identifying clinically node-negative. patients requiring axillary lymph node dissection? Ann Surg. 2016;222:138-145.
13.- Morrow M. A new era in axillary management for node-positive womem. June. 2016. Accessed March 2023. https://www.mskcc.org/clinical-updates/new-era-axillarymanagement-node-positive-women.
14.- Morrow M, Van Zee K, Patil S, Petruolo O, Mamtami A, Barrio A, et al. Axillary dissection and nodal irradiation can be avoided for most node-positive Z0011- eligible breast cancers. Ann Surg. 2017;266:457-461.
15.- Caudle AS, Kuerer HM, Le-Petross HT, Yang W, Yi M, Bedrosian I, et al. Predicting the extent of nodal disease in early-stage breast cancer. Ann.Surg.Oncol. 2014;21:3440-3447.
16.- Farrell T, Adams N, Stenson M, Carroll P, Griffin M, Connolly E, et al. The Z0011 trial: is the end of axillary ultrasound in the pre-operative assessment of breast cancer patients? Eur.Radiol. 2015;25:2682-2687.
17.- Boone B, Huynh C, Spangler M, Sumkin J, Johnson R, McGuire K, et al. Axillary limph node burden in invasive breast cancer: a comparison of the predictive value of ultrasound-guided needle biopsy and sentinel lymph node biopsy. Clin Breast Cancer. 2015;15:243-248.
18.- Van Wely BJ, de Wilt JH, Schout PJ, Kooistra B, Wauters CA, Vendernck D, et al. Ultrasound-guided fine-needle. aspiration of suspicious nodes in breast cancer patients; selecting patients. with extensive nodal involvement. Breast Cancer Res Treat. 2013;140:113-118.
19.- Verheuvel N, van der Hoven I, Ooms W, Voogd A, Roumen R. The role of. ultrasound-guided lymph node biopsy in axillary staging of invasive breast. cancer in the post-ACOSOG Z0011 trial era. Ann.Surg.Oncol. 2015;22:409-415.
20. Del Riego J, Díaz-Ruiz M, Teixidó M, Ribé J, Vilagran M, Canales D, et al. The impact of axillary ultrasound with biopsy in overteatment of early breast cancer. Eur J Radiol. 2018;98: 158-164.
21.- Buzatto I, Dos Reis J, Moreira J, Gomes T, Camargo J, Netto A, Sconzo M, Guimarães D:. Axillary ultrasound and fine-needle aspiration cytology to predict clinically relevant nodal burden in breast cancer patients. World Journal of Surgical Oncology. 2021;19:292-300.
22.- Hieken TJ, Trull BC, Boughey JC, Jones K , Reynolds C , Shah S , Glazebrook K et al. Preoperative axillary imaging with percutaneous lymph node biopsy is valuable in the contemporary management of patients with breast cancer. Surgery. 2013;154(4):831–8