Axillary ultrasonography for early-stage invasive breast cancer

Karen Jiang; Crystal Ma; Yuwei Yang; Elaine McKevitt; Jin-Si Pao; Rebecca Warburton; Carol Dingee; Jieun Newman- Bremang; Melina Deban; Amy Bazzarelli

doi:10.1016/j.amjsurg.2024.03.011

Axillary ultrasonography for early-stage invasive breast cancer

Am J Surg. 2024 May:231:86-90. doi: 10.1016/j.amjsurg.2024.03.011. Epub 2024 Mar 8.

Authors

Karen Jiang¹, Crystal Ma², Yuwei Yang³, Elaine McKevitt⁴, Jin-Si Pao⁵, Rebecca Warburton⁶, Carol Dingee⁷, Jieun Newman- Bremang⁸, Melina Deban⁹, Amy Bazzarelli¹⁰

Affiliations

¹ Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. Electronic address: karenjng@student.ubc.ca.
² Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. Electronic address: cma7338@student.ubc.ca.
³ Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: yuwei.yang@vch.ca.
⁴ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: emckevitt@providencehealth.bc.ca.
⁵ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: jpao@providencehealth.bc.ca.
⁶ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: rwarburton@providencehealth.bc.ca.
⁷ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: cdingee2@providencehealth.bc.ca.
⁸ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: jnewmanbremang@providencehealth.bc.ca.
⁹ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: mdeban@providencehealth.bc.ca.
¹⁰ Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada; Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada. Electronic address: abazzarelli@providencehealth.bc.ca.

PMID: 38490879
DOI: 10.1016/j.amjsurg.2024.03.011

Abstract

Background: Among women with early invasive breast cancer and 1-2 positive sentinel nodes, sentinel lymph node biopsy (SLNB) is non-inferior to axillary lymph node dissection (ALND).^1-3 However, preoperative axillary ultrasonography (AxUS) may not be sensitive enough to discriminate burden of nodal metastasis in these patients, potentially leading to overtreatment.^4-6 This study compares axillary operation rates in patients who did and did not receive preoperative AxUS, assessing its utility and risks for overtreatment.

Methods: This is a retrospective cohort study of patients with clinical T1/T2 breast tumors who were clinically node negative and underwent an axillary operation.

Results: Patients who had preoperative AxUS received more ALND compared to patients who did not (5.6% vs. 1.4%, p < 0.001). There was no significant difference in the number of additional axillary operations following SLNB (2.1% vs. 2.3%, p = 0.77).

Conclusion: Eliminating preoperative AxUS is associated with fewer invasive ALND procedures, without increased rate of axillary reoperations.

Keywords: Axillary lymph node dissection; Axillary ultrasonography; Early invasive breast cancer; Sentinel lymph node biopsy.

MeSH terms

Axilla / diagnostic imaging
Axilla / pathology
Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Female
Humans
Lymph Node Excision
Lymph Nodes / pathology
Lymphatic Metastasis / pathology
Neoplasm Staging
Retrospective Studies
Sentinel Lymph Node Biopsy / methods
Ultrasonography / methods