Alexis Virginia Nees MD, Presenter: Nothing to Disclose

Mark Alan Helvie MD, Abstract Co-Author: Nothing to Disclose

Stephanie Kay Patterson MD, Abstract Co-Author: Nothing to Disclose

Marilyn A. Roubidoux MD, Abstract Co-Author: Nothing to Disclose

Lisa Newman MD, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to report the sonographic assessment of axillary lymph nodes(LN) in patients newly diagnosed with breast cancer and compare the cytologic results of ultrasound guided fine needle aspiration(USFNA) with surgical pathology to stage the axilla.

IRB approval obtained. We retrospectively reviewed the pathology and ultrasound(US) results of patients newly diagnosed with invasive breast cancer over a 20 month period. All patients were evaluated with physician performed axillary US following surgical referral for newly diagnosed breast cancer and prior to definitive surgical treatment. US appearance of the axillary LN was considered abnormal if: the contour was bulbous, the cortex was asymmetrically thickened, or there was flattening or loss of the fatty hilum. USFNA was performed with a 22 gauge needle using a minimum of 2 passes. All patients underwent subsequent surgical treatment of the primary breast cancer and axillary LN with axillary dissection or Sentinel lymph node sampling(SLNS).

57 of 68(83.8%) patients had complete records. 57 patients comprised the study population. 40 of 57(70.2%) axillary ultrasounds were abnormal. 37 of 40(92.5%)were found to have metastatic disease. 3 of 40(7.5%) had negative pathology. 17 of 57(29.8%)axillary ultrasounds were normal. 8 of 17(47.1%)cases with normal axillary US had metastatic disease. 9 of 17(52.9%) had negative pathology. The sensitivity of axillary US was 82.2% and specificity 75%. USFNA was performed in 31 of 40(77.5%) patients with abnormal axillary US. 26 of 31(83.9%)USFNA were positive for metastatic disease. 26 of 26(100%) had evidence of metastatic disease at surgical sampling. 5 of 31(16.1%)USFNA were negative. 3 of 5(60%)had no evidence of metastatic disease at surgical sampling. 2 of 5(40%)had evidence of metastatic disease at surgical sampling. The sensitivity of USFNA was 92.8% and the specificity 100%.

In women newly diagnosed with breast cancer, USFNA of sonographically abnormal axillary LN achieves high sensitivity and specificity. When pre-operative staging of the axilla with US and USFNA demonstrates metastatic disease, SLNS may not be needed prior to axillary dissection.

Nees, A, Helvie, M, Patterson, S, Roubidoux, M, Newman, L, Pre-operative Staging of the Axilla in Women Recently Diagnosed with Breast Cancer: Accuracy of Axillary Ultrasound and Ultrasound-guided Fine Needle Aspiration.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4407162.html