Annals of Surgical Oncology Sign the Guestbook
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
10.1245/ASO.2005.09.007
Annals of Surgical Oncology 12:697-704 (2005)
© 2005 Society of Surgical Oncology
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Khan, A.
Right arrow Articles by Newman, L. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Khan, A.
Right arrow Articles by Newman, L. A.

Original Article

Comprehensive Axillary Evaluation in Neoadjuvant Chemotherapy Patients With Ultrasonography and Sentinel Lymph Node Biopsy

Amina Khan, MD1, Michael S. Sabel, MD1, Alexis Nees, MD2, Kathleen M. Diehl, MD1, Vincent M. Cimmino, MD1, Celina G. Kleer, MD3, Anne F. Schott, MD4, Dan F. Hayes, MD4, Alfred E. Chang, MD1 and Lisa A. Newman, MD, MPH1

1 Department of Surgery, Comprehensive Cancer Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109
2 Department of Radiology, Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan 48109
3 Department of Pathology, Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan 48109
4 Department of Medical Oncology, Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan 48109

Correspondence: Address correspondence and reprint requests to: Lisa A. Newman, MD, MPH; E-mail: lanewman{at}umich.edu

Background: There is ongoing debate regarding the optimal sequence of sentinel lymph node (SLN) biopsy and neoadjuvant chemotherapy (CTX) for breast cancer. We report the accuracy of comprehensive pre–neoadjuvant CTX and post–neoadjuvant CTX axillary staging via ultrasound imaging, fine-needle aspiration (FNA) biopsy, and SLN biopsy.

Methods: From 2001 to 2004, 91 neoadjuvant CTX patients at the University of Michigan Comprehensive Cancer Center underwent axillary staging by ultrasonography, ultrasound-guided FNA biopsy, SLN biopsy, or a combination of these.

Results: Axillary staging was pathologically negative by pre–neoadjuvant CTX SLN biopsy in 53 cases (58%); these patients had no further axillary surgery. In 38 cases (42%), axillary metastases were confirmed at presentation by either ultrasound-guided FNA or SLN biopsy. These 38 patients underwent completion axillary lymph node dissection (ALND) after delivery of neoadjuvant CTX. Follow-up lymphatic mapping was attempted in 33 of these cases, and the SLN was identified in 32 (identification rate, 97%). One third of these cases were completely node negative on ALND. Residual metastatic disease was identified in 22 cases, and the SLN was falsely negative in 1 (4.5%).

Conclusions: Patients receiving neoadjuvant CTX can have accurate axillary nodal staging by ultrasound-guided FNA or SLN biopsy. In cases of documented axillary metastasis at presentation, repeat axillary staging with SLN biopsy can document the post–neoadjuvant CTX nodal status. This strategy optimizes pre–neoadjuvant CTX and post–neoadjuvant CTX staging information by distinguishing the patients who are node negative at presentation from those who have been downstaged to node negativity and offers the potential for avoiding unnecessary ALNDs in both of these patient subsets.

Key Words: Neoadjuvant chemotherapy • Breast cancer • Axilla • Ultrasound • Sentinel node




This article has been cited by other articles:


Home page
 Ann. Surg. Oncol.Home page
K. E. Kilbride, M. C. Lee, A. V. Nees, V. M. Cimmino, K. M. Diehl, M. S. Sabel, D. F. Hayes, A. F. Schott, C. G. Kleer, A. E. Chang, et al.
Axillary Staging Prior to Neoadjuvant Chemotherapy for Breast Cancer: Predictors of Recurrence
Ann. Surg. Oncol., November 1, 2008; 15(11): 3252 - 3258.
[Abstract] [Full Text] [PDF]

Home page
 Arch SurgHome page
B. J. Grube, C. J. Christy, D. Black, M. Martel, L. Harris, J. Weidhaas, M. P. DiGiovanna, G. Chung, M. M. Abu-Khalaf, K. D. Miller, et al.
Breast Sentinel Lymph Node Dissection Before Preoperative Chemotherapy
Arch Surg, July 1, 2008; 143(7): 692 - 700.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
A. Jain, M. E. Haisfield-Wolfe, J. Lange, N. Ahuja, N. Khouri, T. Tsangaris, Z. Zhang, C. Balch, and L. K. Jacobs
The Role of Ultrasound-Guided Fine-Needle Aspiration of Axillary Nodes in the Staging of Breast Cancer
Ann. Surg. Oncol., February 1, 2008; 15(2): 462 - 471.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
E. A. Newman, M. S. Sabel, A. V. Nees, A. Schott, K. M. Diehl, V. M. Cimmino, A. E. Chang, C. Kleer, D. F. Hayes, and L. A. Newman
Sentinel Lymph Node Biopsy Performed After Neoadjuvant Chemotherapy is Accurate in Patients with Documented Node-Positive Breast Cancer at Presentation
Ann. Surg. Oncol., October 1, 2007; 14(10): 2946 - 2952.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
J. T. Davis, Y. M. Brill, S. Simmons, B. C. Sachleben, M. L. Cibull, P. McGrath, H. Wright, E. Romond, M. Hester, A. Moore, et al.
Ultrasound-Guided Fine-Needle Aspiration of Clinically Negative Lymph Nodes Versus Sentinel Node Mapping in Patients at High Risk for Axillary Metastasis
Ann. Surg. Oncol., December 1, 2006; 13(12): 1545 - 1552.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
E. A. Newman, V. M. Cimmino, M. S. Sabel, K. M. Diehl, K. A. Frey, A. E. Chang, and L. A. Newman
Lymphatic Mapping and Sentinel Lymph Node Biopsy for Patients With Local Recurrence After Breast-Conservation Therapy
Ann. Surg. Oncol., January 1, 2006; 13(1): 52 - 57.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2005 by the Society of Surgical Oncology.