Preoperative Staging of the Axilla in Clinically Node Negative Breast Cancer Patients – The Memorial Sloan Kettering Sentinel and Non-Sentinel Nomograms and the University of Kentucky Approach Using Axillary Ultrasound and Fine Needle Aspiration Biopsy.
Robert A Hillard, Yolanda Musgrave, Heather Wright, Patrick Macgrath, Edward Romond, Angela Moore, Luis M Samayoa. University of Kentucky, Lexington; VAMC, Lexington; Instituto Internacional de Cancer, San Salvador, El Salvador
Background: Widespread mammographic screening has resulted in an increased number of patients with node negative (-) disease. Despite Sentinel Node (SN) mapping, an accurate approach for determining the extent of axillary surgery for these patients remains open to debate. This study compares extent of axillary disease using the SN and Non-Sentinel (NSN) Memorial Sloan Kettering Nomograms (MSKN) to previous data obtained using Axillary Ultrasound (AU) and Ultrasound Guided Fine Needle Aspiration Biopsy (US-FNA).
Design: Retrospective data from 204 clinically node (-) cancer patients was entered into the SN and the NSN MSKN (http://www.mskcc.org/mskcc/html/15938.cfm). This data was then compared to our previous results from a different patient population following the algorithm below (1,2,3,4).
Conclusions: While the SN MSKN accurately predicted SN positivity, the NSN MSKN overestimated the risk for additional disease in the axilla; potentially leading to unnecessary extensive surgery in 20% of the patients. Seemingly, the results using the combined US-FNA approach accurately predicted final axillary status (N1a disease) in 97% of the LR patients and in 100% of the HR patients with micrometastatic disease – providing additional data for a more accurate surgical approach.
Monday, February 28, 2011 1:00 PM
Poster Session II # 31, Monday Afternoon