Robert Albert Schmidt MD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Abe MD, Presenter: Nothing to Disclose

Gillian Maclaine Newstead MD, Abstract Co-Author: Nothing to Disclose

Charlene A. Sennett MD, Abstract Co-Author: Nothing to Disclose

SLNB is standard in many centers for staging breast cancer. Ultrasound (US) of the ipsilateral axilla is routinely done at our facility for patients with newly diagnosed invasive breast cancer. Abnormal nodes can be sampled by FNA or core biopsy on US, avoiding sentinel lymph node biopsy (SLNB) in patients with positive findings. We present our initial results using core sampling, as FNA techniques had proved equivocal.

We evaluated nodes for loss of hilum, cortex, size, and vascular pattern on color flow Doppler on a Philips/ATL HDI 5000 US unit using a 5/12 Mhz linear probe. Non-palpable suspicious nodes and palpable nodes with equivocal FNA were sampled an average of 2 times using a 14G automated core biopsy gun (Achieve or Bard Magnum). Our preferred method is to place the needle through the node cortex, then cock only the outer cannula and fire, which avoids uncertainties in needle throw for vessels and nerves.

16 patients met criteria over 9 months. 13 were non-palpable. Sampled nodes averaged 17mm in bipolar length (8-26mm). 13 had blood flow to the cortex from the non hilar side and one had normal distribution but hyperemia. The hilum was abnormal in half, and cortex abnormal in all. 12/16 were positive for metastatic breast cancer. 12/14 with abnormal blood flow were positive (86%). One negative case had SLNB with 0/3 nodes positive. Axillary node dissection (AND) results were available in 7 positive cases of the remaining 15 (1 patient refused and 7 are pending), showing 1 node positive in 3 cases, 3 positive in 1 case, and more than 10 positive in 3 cases (average AND yield was 17 nodes). One patient had bleeding which stopped on compression, one had a self-limited vasovagal reaction, and one had transient pain.

Abnormal axillary nodes identified on ultrasound in patients with breast cancer can be sampled using a modified 14G core needle technique, with high accuracy and no significant complications. Abnormal cortex and color flow patterns have high predictive value in selecting patients who are likely to be positive on core biopsy and can then go on directly to a staging AND. Patients with negative results should still have SLNB at this point.

Schmidt, R, Abe, H, Newstead, G, Sennett, C, Initial Experience with Ultrasound-guided 14G Core Biopsy of Suspicious Axillary Lymph Nodes in Patients with Breast Cancer as an Alternative to Sentinel Lymph Node Biopsy (SLNB).  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4410319.html