Preoperative axillary ultrasonography can prevent unnecessary lymph node surgery
South Korean researchers found that preoperative axillary ultrasonography (US) can decipher which patients are least at-risk for non-sentinel lymph node (SLN) metastasis—possibly resulting in fewer unnecessary lymph node dissections.
The study was published online March 20 in Radiology.
Traditionally, SNL biopsy is used to identify regional lymph node metastases in patients with breast cancer, and axillary lymph node dissection is the common treatment in patients with positive SNLs.
However, corresponding author Ji Soo Choi, MD, PhD with the department of radiology at Inha University School of Medicine and Samsung Medical Center at Sungkyunkwan University School of Medicine, and colleagues noted “43 to 65 percent of patients with positive SLNs have no additional non-SLN metastasis after axillary lymph node dissection and receive unnecessary axillary surgery, which can result in high morbidity.”
The group retrospectively analyzed the electronic medical records of 1802 patients who underwent breast-conserving surgery for clinical T1-2/N0 cancers and SLN biopsy with or without axillary lymph dissection. Of that total, 397 patients were included who had received axillary lymph node dissection due to positive SLN biopsy—76 had non-SLN metastasis at final examination.
Patients with non-SLN metastasis proved to be younger and demonstrated positive axilla during ultrasonography and clinical T2 stage more often. Positive axilla at US, clinical T2 stage and lymphovascular invasion were “significantly” associated with non-SLN metastasis, according to Choi et al.
Among the 1,284 patients with negative axilla, 1,254 did not have non-SLN metastasis and 30 did.
“Preoperative axillary US can help select patients at minimal risk of non–sentinel lymph node metastasis for whom axillary lymph node dissection can be omitted, by using negative axilla at US and clinical T1 stage as criteria,” they wrote.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.