Axillary ultrasound in patients with breast cancer: which lymph nodes should be targeted for fine needle aspiration?

Transcription

1 Axillary ultrasound in patients with breast cancer: which lymph nodes should be targeted for fine needle aspiration? Poster No.: C-0289 Congress: ECR 2011 Type: Scientific Paper Authors: M. J. Diaz-Ruiz, O. Valencoso, A. Arnau, J. Montesinos, P. Culell, L. Solernou, C. Yanguas, J. Trullas, C. Vergara; Manresa/ES Keywords: Breast, Ultrasound, Puncture, Metastases DOI: /ecr2011/C-0289 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 10

2 Purpose Describe the ultrasound semiology of axillary adenopathies in patients with BC and assess the diagnostic accuracy of fine needle aspiration (FNA) findings. Images for this section: Fig. 1: Image shows US-guided FNA technique, with tip of needle in suspicious lymph node. Page 2 of 10

3 Methods and Materials A prospective study of 332 patients (341 axillas) with BC who underwent axillary ultrasound and FNA between June 2005 and July 2009 and were subsequently submitted to axillary surgery. We show the range of changes in the cortical morphologic features classified in 6 types (Bedi* classification), types 1-2 nodes being regarded as benign, and types 3-6 as suspicious for malignancy. We determined the diagnostic accuracy of ultrasound in relation to FNA. Images for this section: Page 3 of 10

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5 Fig. 1: AXILLARY ULTRASOUND IN PATIENTS WITH BREAST CANCER. WHICH LYMPH NODES SHOULD BE TARGETED FOR FNA Page 5 of 10

6 Results Mean age was 61.9 years (SD 14.1), 98.8% were women. Lymph nodes were observed in 172 (50.4%) (positive ultrasound) of the 341 axillary ultrasounds performed. Of these, 25 (14.5%) were type 1, 38 (22.1%) type 2, 1 (0.6%) type 3, 24 (13.9%) type 4, 30 (17.4%) type 5 and 54 (31.4%) type 6. FNA was performed in 154 of the 172 lymph nodes with positive ultrasounds. On the 18 where FNA was not performed, 16 presented type 1-2 lymph nodes (2 were positive at surgery). Of the 79 axillas (51.3%) positive FNA, 2 (2.5%) were type 1, 3 (3.8%) type 2, 10 (12.6%) type 4, 15 (19.0%) type 5, 49 (62.0%) type 6. Sensitivity of ultrasound was 93.7 (CI ), specificity was 56.0 (CI ), PPV=69.2 and NPV=89.4. The 5 axillas with apparently benign lymph nodes (10.6%) were positive FNA and had BC <25mm. Therapeutic option was changed and selective sentinel lymph node biopsy (SSLNB) avoided. Images for this section: Page 6 of 10

7 Fig. 1: Image of axillary lymph node shows oval shape, thin cortex, and central fatty hilum. Both cytologic findings at US-guided FNA and histologic findings at SSLNB were positive. Fig. 2: Sagital US image of indeterminate axillary lymph node shows central fatty hilum and uniform, although slightly thickened, cortex. Both cytologic findings at US-guided FNA and histologic findings at SSLNB were positive. Page 7 of 10

8 Fig. 3: Image shows lymph node characterized by focal hypoechoic lobulation of cortex due to metastatic deposit. Both cytologic findings at US-guided FNA and histologic findings at SSLNB were positive. Fig. 4: Completely hypoechoic lymph node with no hilum owing to metastatic replacement. Page 8 of 10

9 Conclusion FNA is performed on suspicious lymph nodes due to the high percentage of positive predictive value (100%). Yet it also should be performed in morphologically benign lymph nodes in patients with BC <3cm as it led avoid 10,4% (5/47) SSLNB. FNA allows fast presurgical staging in patients with axillary metastasis from BC, and facilitates therapeutic decisions. References - Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD, et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am.J.Roentgenol Sep;191(3): Banerjee M, George J, Song EY, Roy A, Hryniuk W. Tree-based model for breast cancer prognostication. J.Clin.Oncol Jul 1;22(13): Cianfrocca M, Goldstein LJ. Prognostic and predictive factors in early-stage breast cancer. Oncologist 2004;9(6): Altomare V, Guerriero G, Carino R, Battista C, Primavera A, Altomare A, et al. Axillary lymph node echo-guided fine-needle aspiration cytology enables breast cancer patients to avoid a sentinel lymph node biopsy. Preliminary experience and a review of the literature. Surg.Today 2007;37(9): Van der Valk P, Meijer CJL. Histology for pathologists. In: Lippincott Raven, editor. 2nd ed. Philadelphia: Stenberg SS, ed; p Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM. Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge coreneedle biopsy: clinical experience in 100 patients. Radiology 2009 Jan;250(1): Koelliker SL, Chung MA, Mainiero MB, Steinhoff MM, Cady B. Axillary lymph nodes: USguided fine-needle aspiration for initial staging of breast cancer: correlation with primary tumor size. Radiology 2008 Jan;246(1): Page 9 of 10

10 Personal Information M. J. Diaz-Ruiz, O. Valencoso, A. Arnau, J. Montesinos, P. Culell, L. Solernou, C. 1 1 Yanguas, J. Trullas, C. Vergara 5 1 Radiology Service. 2 Innovation and Research Unit. 3 Breast Cancer Unit. 4 Surgery Service. 5 Pathology Service. Fundació Althaia, Xarxa Assistencial de Manresa. C/ Dr. Soler s/n Manresa, (Barcelona) Spain. María Jesús Diaz-Ruiz, Ph.D Corresponding author at mdiaz@althaia.cat Page 10 of 10