Does a Positive Axillary Lymph Node Needle Biopsy Result Predict the Need for an Axillary Lymph Node Dissection in Clinically ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-04

AUTHORS

Melissa Pilewskie, Starr Koslow Mautner, Michelle Stempel, Anne Eaton, Monica Morrow

ABSTRACT

BACKGROUND: American College of Surgeons Oncology Group (ACOSOG) Z0011 defined clinical node negativity by physical examination alone. Although axillary ultrasound with biopsy has a positive predictive value for lymph node (LN) metastases approaching 100 %, it may not appropriately identify clinically node-negative women with ≥3 positive LNs who require axillary lymph node dissection (ALND). We sought to identify the total number of positive LNs in women presenting with cT1-2N0 breast carcinoma with a positive preoperative LN biopsy to evaluate the potential for overtreatment when ALND is performed on the basis of a positive needle biopsy in patients who otherwise meet ACOSOG Z0011 eligibility criteria. METHODS: Patients with cT1-2N0 breast cancer by physical examination with a positive preoperative LN biopsy were identified from a prospective institutional database. Clinicopathologic characteristics and axillary imaging results were compared between women with 1 to 2 total positive LNs and ≥3 total positive LNs. RESULTS: Between May 2006 and December 2013, a total of 141 women with cT1-2N0 breast cancer had abnormal axillary imaging and a preoperative positive LN biopsy (median patient age 51 years, median tumor size 2.4 cm, 86 % ductal histology, 79 % estrogen receptor positive). Sixty-six women (47 %) had 1 to 2 total positive LNs, and 75 (53 %) had ≥3 total positive LNs. Women with ≥3 total positive LNs had larger tumors (2.4 vs. 2.2 cm, p = 0.03), fewer tumors with ductal histology (79 vs. 94 %, p = 0.01), more lymphovascular invasion (80 vs. 61 %, p = 0.01), and higher median body mass index (29.2 vs. 27.1 kg/m(2), p = 0.04). Having >1 abnormal LN on axillary imaging was significantly associated with having ≥3 total positive LNs at final pathology (68 vs. 43 %, p = 0.003). CONCLUSIONS: Axillary imaging with preoperative LN biopsy does not accurately discriminate low- versus high-volume nodal disease in clinically node-negative patients. More... »

PAGES

1123-1128

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-015-4944-y

DOI

http://dx.doi.org/10.1245/s10434-015-4944-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1003559923

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26553439


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    "description": "BACKGROUND: American College of Surgeons Oncology Group (ACOSOG) Z0011 defined clinical node negativity by physical examination alone. Although axillary ultrasound with biopsy has a positive predictive value for lymph node (LN) metastases approaching 100\u00a0%, it may not appropriately identify clinically node-negative women with \u22653 positive LNs who require axillary lymph node dissection (ALND). We sought to identify the total number of positive LNs in women presenting with cT1-2N0 breast carcinoma with a positive preoperative LN biopsy to evaluate the potential for overtreatment when ALND is performed on the basis of a positive needle biopsy in patients who otherwise meet ACOSOG Z0011 eligibility criteria.\nMETHODS: Patients with cT1-2N0 breast cancer by physical examination with a positive preoperative LN biopsy were identified from a prospective institutional database. Clinicopathologic characteristics and axillary imaging results were compared between women with 1 to 2 total positive LNs and \u22653 total positive LNs.\nRESULTS: Between May 2006 and December 2013, a total of 141 women with cT1-2N0 breast cancer had abnormal axillary imaging and a preoperative positive LN biopsy (median patient age 51\u00a0years, median tumor size 2.4\u00a0cm, 86\u00a0% ductal histology, 79\u00a0% estrogen receptor positive). Sixty-six women (47\u00a0%) had 1 to 2 total positive LNs, and 75 (53\u00a0%) had \u22653 total positive LNs. Women with \u22653 total positive LNs had larger tumors (2.4 vs. 2.2\u00a0cm, p\u00a0=\u00a00.03), fewer tumors with ductal histology (79 vs. 94\u00a0%, p\u00a0=\u00a00.01), more lymphovascular invasion (80 vs. 61\u00a0%, p\u00a0=\u00a00.01), and higher median body mass index (29.2 vs. 27.1\u00a0kg/m(2), p\u00a0=\u00a00.04). Having >1 abnormal LN on axillary imaging was significantly associated with having \u22653 total positive LNs at final pathology (68 vs. 43\u00a0%, p\u00a0=\u00a00.003).\nCONCLUSIONS: Axillary imaging with preoperative LN biopsy does not accurately discriminate low- versus high-volume nodal disease in clinically node-negative patients.", 
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47 schema:description BACKGROUND: American College of Surgeons Oncology Group (ACOSOG) Z0011 defined clinical node negativity by physical examination alone. Although axillary ultrasound with biopsy has a positive predictive value for lymph node (LN) metastases approaching 100 %, it may not appropriately identify clinically node-negative women with ≥3 positive LNs who require axillary lymph node dissection (ALND). We sought to identify the total number of positive LNs in women presenting with cT1-2N0 breast carcinoma with a positive preoperative LN biopsy to evaluate the potential for overtreatment when ALND is performed on the basis of a positive needle biopsy in patients who otherwise meet ACOSOG Z0011 eligibility criteria. METHODS: Patients with cT1-2N0 breast cancer by physical examination with a positive preoperative LN biopsy were identified from a prospective institutional database. Clinicopathologic characteristics and axillary imaging results were compared between women with 1 to 2 total positive LNs and ≥3 total positive LNs. RESULTS: Between May 2006 and December 2013, a total of 141 women with cT1-2N0 breast cancer had abnormal axillary imaging and a preoperative positive LN biopsy (median patient age 51 years, median tumor size 2.4 cm, 86 % ductal histology, 79 % estrogen receptor positive). Sixty-six women (47 %) had 1 to 2 total positive LNs, and 75 (53 %) had ≥3 total positive LNs. Women with ≥3 total positive LNs had larger tumors (2.4 vs. 2.2 cm, p = 0.03), fewer tumors with ductal histology (79 vs. 94 %, p = 0.01), more lymphovascular invasion (80 vs. 61 %, p = 0.01), and higher median body mass index (29.2 vs. 27.1 kg/m(2), p = 0.04). Having >1 abnormal LN on axillary imaging was significantly associated with having ≥3 total positive LNs at final pathology (68 vs. 43 %, p = 0.003). CONCLUSIONS: Axillary imaging with preoperative LN biopsy does not accurately discriminate low- versus high-volume nodal disease in clinically node-negative patients.
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