Preoperative Identification of N1a Disease in Clinically Node Negative Breast Cancer Patients
Rachel L Stewart, Patrick C McGrath, Heather Wright, Alex L Szabunio, Elaina A Pirruccello, Yolanda M Brill, Vera V Krol, Roshan K Patel, Luis M Samayoa. University of Kentucky, Lexington, KY; Lexington VA Medical Center, Lexington, KY
Background: Between 20 to 30% of patients undergoing Sentinel Node Biopsy (SNB) will have N1a disease. Results from the ACOSOG – 0011 trial strongly suggest that when treated appropriately, axillary lymph node dissections (ALND) are probably not needed in N1a patients with 1-2 (+) Lymph Nodes (LN). This study focuses in how to select these patients preoperatively and evaluates the need for Sentinel Node (SN) Intraoperative Consults (IOC) using a combined multidisciplinary approach.
Design: See figure 1
Results: See figure 2
Conclusions: In all likelihood, clinically node (-) patients with normal or without significant sonographic LN abnormalities (cortical defects < 5mm in ≥ 1 LN) require SNB only for their axillary staging. SN IOC may be safely bypassed in these patients since its result are unlikely to impact the extent of their ALND. Unless the mapping fails and /or small suspicious LN (not detected by US +/- FNA) are identified at the time of surgery, IOC could be left at the surgeon's discretion alone.
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 19, Wednesday Morning