Angela Moore MD, Presenter: Nothing to Disclose

Moon-woo Nam, Abstract Co-Author: Nothing to Disclose

Molly Young Hester MD, Abstract Co-Author: Nothing to Disclose

Patrick McGrath, Abstract Co-Author: Nothing to Disclose

Heather Wright, Abstract Co-Author: Nothing to Disclose

Luis M. Samayoa, Abstract Co-Author: Nothing to Disclose

To assess the clinical relevance, pitfalls/limitations and common findings of axillary ultrasound (US)/ultrasound guided fine needle aspiration (US-FNA) in clinically node negative (–) patients at high risk for nodal metastases. To present a clinical model that may provide information regarding axillary status in a single outpatient visit.

After IRB approval, US axillary surveys from clinically node (-) patients at high risk for axillary metastases (high grade breast tumors, > 1 cm with ± lymphvascular invasion) were retrospectively reviewed for the following: asymmetric cortical thickening/lobulations, hypoechoic cortex, loss/compression of the mediastinum, absence of a fatty hilum, rounded shape, admixture of normal/abnormal appearing lymph nodes (LN) and increased peripheral blood flow (Stavros). This data was compared to US-FNA and final histology. Costs of axillary US and axillary US-FNA were compared to those of sentinel node (SN) mapping. Primary tumor size was based on US or mammography.

One out of three clinically node (-) patients required axillary US +/- US-FNA. On final histology, 60% of these patients had positive (+) axilla, 40% of which were diagnosed by US-FNA, reducing health care costs by 20%. The most common (+) US finding was asymmetric cortical thickening/lobulations. US findings were not affected by the modality used to diagnose the primary tumor. Single fatty replaced LNs harboring metastatic deposits < 8 mm were more likely to be missed by US ± US-FNA. Patients with (-) axillary US/(-) US-FNA remained node (-) in 70% of the cases or had minimal disease. One third of our patients with breast primaries diagnosed by FNA knew their (+) axillary status at the end of a single outpatient encounter.

This study suggests that in clinically node (-) patients at increased risk for axillary metastases the use of US evaluation of the axilla in combination with US-FNA is, not only clinically justified, but also cost-effective.

In high risk patients, axillary US and US-FNA may reduce health care costs up to 20%. When asymmetric cortical thickening/lobulations are seen, nodal involvement should be suspected.

Moore, A, Nam, M, Hester, M, McGrath, P, Wright, H, Samayoa, L, Preoperative Sonographic Survey of Axillary Lymph Nodes in Breast Cancer Patients at Higher Risk for Regional Lymph Node Metastases.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4435900.html