Aimee Pamela Carswell MD, Presenter: Nothing to Disclose

N. Carol Dornbluth MD, Abstract Co-Author: Nothing to Disclose

Andres Rahal MD, Abstract Co-Author: Nothing to Disclose

Rulon Hardman MD, Abstract Co-Author: Nothing to Disclose

Nicole Walker, Abstract Co-Author: Nothing to Disclose

To evaluate the relationship between tumor size, tumor palpability, tumor type/grade, molecular markers and node palpability with metastatic axillary lymph node (LN) status in patient with breast carcinoma.

Retrospective chart review of clinical records between February 2006 and March 2008 selected 77 women with pathologically proven breast carcinoma (excluding DCIS) who underwent ultrasound guided (USG) core needle biopsy of an axillary lymph node prior to breast surgery. Indications for lymph node biopsy included palpability or suspicious ultrasound criteria, each of which were determined by the radiologist performing the diagnostic mammogram. Variables included primary tumor size, number, palpability and type/grade, molecular markers (ER, PR, Her2/neu, Ki 67 proliferation index) and LN palpability. All patients proceeded to breast surgery, sentinel lymph node biopsy and/ or axillary dissection. Histopathology of USG biopsy and/ or surgical specimen determined the endpoint result of positive LN metastasis. Logistic regression analysis was used to assess relationship between tumor characteristics and LN status in 74 patients, of which complete surgical data was available.

Axillary lymph node metastases were detected in 56/74 patients. USG biopsy showed sensitivity of 85.7% and specificity of 100.0% compared with surgical pathology (ROC area under the curve of 93%). Of various parameters tested, only presence of palpable LN was related to LN metastasis with odds ratio (OR) of 20.2 (95% CI 1.7-238.9). Chi square was 23.39, p<0.016. Despite the relationship between palpable LN and metastasis, only 50.0% (28/56) of patients with LN metastasis had a palpable LN. Alternatively, if a LN was palpable, 96.4% were associated with metastasis.

Despite ongoing attempts to identify factors that may predict axillary LN status in breast cancer, the only statistically significant relationship in our study was for palpable LN, which is the historical surgical method of raising concern for LN metastases.

Higher risk of lymph node metastasis was found in breast cancer patients who had abnormal lymph nodes by palpation or by ultrasound exam. They may benefit from chemotherapy before mastectomy.

Carswell, A, Dornbluth, N, Rahal, A, Hardman, R, Walker, N, Predicting Axillary Metastatic Disease in the Breast Cancer Patient prior to Surgery: Relationship between Tumor Characteristics and Nodal Status.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8007569.html