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Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer

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Abstract

The aim of this study was to see how effective ultrasound-guided needle biopsy was at detecting lymph node involvement in patients with early breast cancer. Patients with newly diagnosed invasive breast cancer underwent axillary ultrasound (US) where lymph node size and morphology were noted. A core biopsy (CB) was undertaken of any node greater than 5 mm in longitudinal section. Patients with benign CBs proceeded to sentinel lymph node (SLN) biopsy, whereas those with malignancy underwent axillary lymph node dissection (ALND). US and CB findings were correlated with final surgical histology in all cases. One hundred and thirty-nine patients were examined, of whom 52.5% had lymph node metastases on final histology. One hundred and twenty-one patients (87%) underwent axillary node CB. The overall sensitivity of CB for detecting lymph node metastases was 53.4% (60.3% for macrometastases; 26.7% for micrometastases). The US morphological characteristics most strongly associated with malignancy were absence of a hilum and a cortical thickness greater than 4 mm. However, one third of patients with normal lymph node morphology had nodal metastases, and only 12% of these were diagnosed on CB. CB of axillary lymph nodes can diagnose a substantial number of patients with lymph node metastases, allowing these patients to proceed directly to ALND, avoiding unnecessary SLN biopsy.

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Acknowledgements

This project was generously funded by the RCR Kodak Sponsorship. The authors would like to thank Dr R Warren, Dr A Eleti, Dr P Moyle and Dr E Senior for performing some of the axillary biopsies and the Cambridge Breast Unit Breast Care Nurse Specialists for their suggestions, support and help with recruiting patients for this study. G.C. Wishart was supported with research funding from the NIHR Cambridge Biomedical Research Centre.

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Authors and Affiliations

  1. Department of Radiology Cambridge Breast Unit, Box 97, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, UK

    P. D. Britton, A. Goud, S. Barter, A. Freeman, M. Gaskarth, P. Rajan, R. Sinnatamby & J. Slattery

  2. Cambridgeshire Primary Care Trust, Cambridge, UK

    S. Godward

  3. Department of Pathology, Addenbrooke’s Hospital Cambridge, Cambridge, UK

    E. Provenzano & M. O’Donovan

  4. Department of Pathology, Guy’s, King’s, Thomas’s, London, UK

    S. Pinder

  5. Department of Surgery, Cambridge Breast Unit, Cambridge, UK

    J. R. Benson, P. Forouhi & G. C. Wishart

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  1. P. D. Britton
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  2. A. Goud
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  3. S. Godward
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  4. S. Barter
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  5. A. Freeman
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  6. M. Gaskarth
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  7. P. Rajan
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  8. R. Sinnatamby
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  9. J. Slattery
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  10. E. Provenzano
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  11. M. O’Donovan
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  12. S. Pinder
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  13. J. R. Benson
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  14. P. Forouhi
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  15. G. C. Wishart
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Correspondence to P. D. Britton.

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Britton, P.D., Goud, A., Godward, S. et al. Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer. Eur Radiol 19, 561–569 (2009). https://doi.org/10.1007/s00330-008-1177-5

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  • DOI: https://doi.org/10.1007/s00330-008-1177-5

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