Can Preoperative Ultrasonography and MRI Replace Sentinel Lymph Node Biopsy in Management of Axilla in Early Breast Cancer-a Prospective Study from a Tertiary Cancer Center
- PMID: 31496596
- PMCID: PMC6708010
- DOI: 10.1007/s13193-019-00924-7
Can Preoperative Ultrasonography and MRI Replace Sentinel Lymph Node Biopsy in Management of Axilla in Early Breast Cancer-a Prospective Study from a Tertiary Cancer Center
Abstract
Although SLNB is a less invasive procedure in detecting axillary lymph node metastases(ALNM) in early breast cancer; still, it carries some complications like lymphedema and in addition, performing SLNB requires surgical skills, technical knowledge, presence of facility like preoperative sentinel lymphoscintigraphy, and availability of hand-held gamma probe for intraoperative assessment. We calculated the relative diagnostic strength of preoperative axillary USG and MRI and compared with of SLNB for detection of ALNM in early breast cancer and assessed whether MRI and USG could accurately predict axillary LN status, potentially replacing SLNB. We evaluated 40 cases of clinically node-negative early breast cancer with preoperative axillary USG and MRI and subsequently subjected to SLNB. The sensitivity, specificity, PPV, NPV, and accuracy of axillary USG were 62.5%, 96.88%, 88.33%, 91.18%, and 90% respectively (p value < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of MRI in detection of ALNM were 75%, 93.75%, 75%, 93.75%, and 90% (p value < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of combined USG and MRI in detection of ALNM were 87.5%,90.63%, 70%, 96.67%, and 90% respectively (p value < 0.001), which are comparable to previous study series. The diagnostic performance of combined approach of axillary USG and MRI is promising, as the NPV of combined USG and MRI is approaching the NPV of the SLNB in detecting ALNM. Based on above findings, if axillary LNs are found nonsuspicious in preoperative axillary USG and MRI, further axillary dissection may be avoided, and if found suspicious, then ALND may be directly proceeded avoiding SLNB in between.
Keywords: MR mammography; Sentinel node biopsy; USG breast.
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References
-
- Mansel RE, Fallowfield L, Kissin M, England D, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst. 2006;98(9):599–609. - PubMed
-
- Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567–575. - PubMed
-
- Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, Weaver DL, Miller BJ, Jalovec LM, Frazier TG, Noyes RD, Robidoux A, Scarth HM, Mammolito DM, McCready D, Mamounas EP, Costantino JP, Wolmark N, National Surgical Adjuvant Breast and Bowel Project Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8(10):881–888. - PubMed
-
- Shah-Khan M, Boughey JC. Evolution of axillary nodal staging in breast cancer: clinical implications of the ACOSOG Z0011 trial. Cancer Control. 2012;19:267–276. - PubMed
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