Negative axillary ultrasonography with biopsy may predict non-involvement of the non-sentinel lymph nodes in operable breast cancer patients

Aim: To evaluate whether axillary ultrasound in combination with a biopsy (AUS +/- Bx) can predict the involvement of the non-sentinel lymph nodes (NSLN).

Methods: A review of all operable breast cancer patients who underwent AUS +/- Bx at our tertiary care center from January 2010 to April 2011 was performed. All patients underwent AUS as part of their pre-operative evaluation. If the AUS was suspicious, a fine-needle aspiration or core-needle biopsy was performed.

Results: Of 88 patients included in our final analysis, 20 (23%) had positive AUS + Bx and underwent axillary lymph node dissection (ALND) at time of definitive surgery. In all, 68 of the 88 patients (77.3%) had negative AUS +/- Bx and underwent sentinel lymph node (SLN) Bx at the time of definitive surgery. If the SLN Bx was negative, no further axillary surgery was performed and the NSLN were assumed to be negative. If the SLN Bx was positive, ALND was performed. Of the 68 patients, 62 (91%) had a negative NSLN. Patients with positive AUS + Bx carry a relative risk of 2.02 (P < 0.00002) of having positive NSLN.

Conclusion: In operable breast cancer patients, a negative AUS+/- Bx may be a predictor of non-involvement of the NSLN.