Controversies Generated by Complete Axillary Dissections Prompted by (+) Ultrasound Guided Fine Needle Aspiration Biopsy in Clinically Node (-) Breast Cancer Patients
Vera V Krol, Elaina A Pirruccello, John J Krol, Patrick C McGrath, Roshan K Patel, Rachel L Stewart, Alex L Szabunio, Yolanda M Brill, Luis M Samayoa. University of Kentucky, Lexington, KY; VAMC, Lexington, KY
Background: Ultrasound Guided Fine Needle Aspiration (US-FNA) is being increasingly used for staging the axilla preoperatively. Overall this approach identifies 30 - 40 % of patients with occult metastasis. However, Complete Axillary Dissections (CAD) after a (+) US-FNA in patients with minimal disease may be considered overly aggressive. This study focuses in the selection of patients that will benefit the most from this procedure.
Design: See Figure 1
Results: See Figure 2
Conclusions: To avoid overtreating the axilla, this study suggests: 1- That CAD should only be performed after a (+) US-FNA when the corresponding sonographic findings show strong evidence of N2-3 disease. 2- That patients with small (< 5mm) isolated, single node cortical abnormalities will not benefit from a US-FNA and 3 - That the extent of axillary surgery in patients with cortical abnormalities > 5mm in > 1 LN must be a limited one. In these patients either with a (+) US-FNA or a (+) SNB, the surgeon should be aware of the possible extent of disease and plan the dissection accordingly.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 25, Wednesday Morning