Combined Approach for Staging the Axilla Versus Sentinel Lymph Node Alone – A Cost Effective Approach Limiting the Extent of Axillary Dissections in Breast Cancer Patients
Elaina A Pirruccello, Patrick C McGrath, Vera V Krol, Roshan K Patel, Rachel L Stewart, Yolanda M Brill, Alex L Szabunio, Luis M Samayoa. University of Kentucky, Lexington, KY; VAMC, Lexington, KY
Background: Local control and prognostic information for managing the majority of clinically node (-) breast cancer patients can be achieved by sentinel node biopsy (SNB) alone, or axillary dissections limited to 1-3 Lymph Nodes (LN). Currently, 20 - 30% of clinically node (-) patients have additional surgery at a significant risk and without clear benefit for survival. This study compares the results from staging the axilla using the current methodology (SNB alone) versus the results from using a combined, multidisciplinary and cost effective approach shown below.
Design: Primary tumor histologic characteristics, axillary ultrasound (US) +/- Fine Needle Aspiration (FNA), SNB and Axillary Lymph Node Dissection (ALND) data from 176 patients, grouped into the following categories: 1) Patients at Low Risk (LR) for axillary metastasis; 2) Patients at High Risk (HR) with normal axillary US; 3) HR patients with US suggesting N1a disease and 4) HR patients with US suggesting N2-3 disease; were analyzed according to: a) Sentinel Node (SN) and Non-Sentinel Node (NSN) status and b) Final number of (+) LN in ALND after a (+) SNB or (+) US-FNA. Patients at HR for axillary metastasis were defined as those having grade II tumors ≥ 1.5 cm and grade III tumors > 1.0 cm. Sonographic abnormalities in the axilla: suggestion of Minimal N1a disease was defined as cortical defects < 5mm in 1-3 LN, suggestion of N1a as cortical defects > 5mm in 1-3 LN, and suggestion of N2-3 disease as complete nodal replacement in 1 LN.
Results: See Table 1
This approach would result in a 38% (48/176) reduction in the number of SNB and a 30% (22/66) reduction in the number of ALND. This translates in to $200,000 (30 - 40%) in procedure-associated savings in our study group.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 16, Wednesday Morning