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For patients with newly diagnosed breast cancer whose nodes appear normal on clinical exam, pathological nodal examination with ultrasound-guided core biopsy offers a greater accuracy rate than fine-needle aspiration, researchers said here at the 33rd annual San Antonio Breast Cancer Symposium (SABCS).

However, ultrasound-guided core biopsy produces a high incidence of false-negatives, according to Joseph Maalo, St. Albans City Hospital, St. Albans, United Kingdom, while noting that it is still the best for initial examination of the axilla, on December 9.

In the study, researchers presented analysis from 229 axillary ultrasound scans between November 2007 and May 2010, some gathered prospectively, and some analysed retrospectively. Of those, 139 were normal or benign on the ultrasound, while those abnormal were biopsied with either the fine-needle aspiration (46 patients) or core biopsy method (44 patients), depending on the preference of the radiologist.

Of those patients with normal ultrasound, 30% were found to be positive on later analysis of a sentinel node biopsy performed at the time of operation. Those patients had to be sent back for re-surgery, according to Dr. Maalo.

However, of the patients who received fine-needle aspiration prior to surgery because of clinically suspect glands, 15 of 29 (52%) who had negative cytology turned out to have cancerous lymph nodes determined by sentinel node biopsy performed at the time of operation.

The figure was lower for those patients with clinically suspect glands who received core biopsy prior to surgery. Of 18 patients whose preoperative core biopsies were negative for cancer, 7 (39%) were later found to be cancerous.

Ultrasound staging of the axilla is superior to clinical staging, the authors concluded. However, there is still a high incidence of false-negative results, making ultrasound a crude way of assessing the axilla and confirming the necessity for sentinel node biopsy in ultrasound-negative axillae.

Source: DG News

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