Preoperative Axillary Ultrasound May Reduce Need for Axillary Lymph Node Dissection

Preoperative axillary ultrasound (US) can help select patients at minimal risk of sentinel lymph node (SLN) metastasis who may not require axillary lymph node dissection, according to a study published in the journal Radiology.

Researchers from Korea evaluated the value of preoperative axillary ultrasound as a tool to prevent unnecessary axillary lymph node dissection after sentinel SLN biopsy in patients with early-stage breast cancers treated with both breast-conserving surgery and SLN biopsy.

The researchers obtained data of 1,802 patients who underwent breast-conserving surgery for clinical T1–2/N0 cancers and SLN biopsy with or without axillary lymph node dissection. Preoperative axillary US results and clinical-pathologic variables were compared according to the status of non-SLN metastasis.

The results showed that of the 1,802 patients, 397 (22 percent) underwent axillary lymph node dissection due to positive SLN biopsy and 76 (4.2 percent) had non-SLN metastasis at final histopathologic examination. The researchers noted that patients with non-SLN metastasis were younger and showed positive axilla at US and clinical T2 stage more frequently. At multivariate analysis, positive axilla at US, clinical T2 stage, and lymphovascular invasion were significantly associated with non-SLN metastasis. Among 1,284 patients with negative axilla at US and clinical T1 stage cancer, 1,254 (97.7 percent) did not have non-SLN metastasis and 30 (2.3 percent) had non-SLN metastasis.

The researchers concluded that use of preoperative axillary US and clinical T stage were associated with the status of non-SLN metastasis in patients with early breast cancer and these. They suggested that preoperative axillary ultrasound can help select patients at minimal risk of non-SLN metastasis, for whom axillary lymph node dissection can be omitted.