Is image-guided core needle biopsy of borderline axillary lymph nodes in breast cancer patients clinically helpful?

Am J Surg. 2022 Jan;223(1):101-105. doi: 10.1016/j.amjsurg.2021.07.021. Epub 2021 Jul 21.

Abstract

Background: When borderline axillary lymph nodes (bALN) are identified on ultrasound (US) for breast cancer (BC) patients, preoperative management is unclear. We aimed to evaluate if core needle biopsy (CNB) for bALN is clinically helpful or disruptive.

Methods: Retrospective review of BC patients with bALN from 2014 to 2019 was performed. Clinicopathologic data were compared for those who did and did not have CNB.

Results: CNB (n = 34) and no CNB (n = 31) were similar with respect to clinicopathologic factors. Surgical LN-positive rate was the same between cohorts (p = 0.26). CNB was disruptive in 58.8 %; all had CNB for pN0 disease. CNB was helpful in 34.2 %: 14.7 % proceeded directly to axillary dissection; 17.6 % had positive LN localized after neoadjuvant chemotherapy.

Conclusions: CNB for bALN is more likely clinically disruptive and did not impact surgical LN positive rate. BC patients with bALN should undergo CNB only if it will change clinical management.

Keywords: Axillary ultrasound; Breast cancer; Clinical stage; Preoperative imaging; Surgical axillary management.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Axilla
  • Biopsy, Large-Core Needle / methods
  • Biopsy, Large-Core Needle / statistics & numerical data
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy
  • Carcinoma, Ductal, Breast / diagnosis*
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Ductal, Breast / therapy
  • Carcinoma, Intraductal, Noninfiltrating / diagnosis*
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Carcinoma, Intraductal, Noninfiltrating / therapy
  • Chemotherapy, Adjuvant
  • Clinical Decision-Making / methods
  • Female
  • Humans
  • Image-Guided Biopsy / methods
  • Image-Guided Biopsy / statistics & numerical data
  • Lymph Node Excision / statistics & numerical data
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology
  • Lymphatic Metastasis / diagnosis*
  • Lymphatic Metastasis / pathology
  • Mastectomy / statistics & numerical data
  • Middle Aged
  • Neoadjuvant Therapy
  • Preoperative Care / methods*
  • Preoperative Care / statistics & numerical data
  • Retrospective Studies
  • Sensitivity and Specificity
  • Sentinel Lymph Node Biopsy / methods
  • Sentinel Lymph Node Biopsy / statistics & numerical data
  • Ultrasonography, Interventional