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Does Every Patient with Breast Cancer Need a Sentinel lymph Biopsy?
*Heather M King, *Susan Koelliker, *Christina Raker, *David Edmonson, *Don Dizon, Jennifer Gass
Women and Infants Hospital, Providence, RI

Objective: Could the use of Axillary Ultrasound Fine needle Aspiration (AXUSFNA) eliminate the need for SLNB in a group of breast cancer patients? We aim to identify the AXUSFNA false negative cohort and describe their characteristics in comparison to the AXUSFNA true positive cohort.
Design: Retrospective Chart Review (1/1/2006-8/1/2009)
Setting: Women and Infants Hospital (WIH) a primary teaching hospital
Patients: Breast Cancer patients who had AXUSFNA identified in radiology registry at WIH. Cross-referenced with tumor registry node positive patients. Study cohort: 134
Main Outcome Measures: AXUSFNA, SLNB and Axillary lymph node dissection (ALND) final pathology. Variables: age, BMI, surgery, histology, grade, lymphovascular invasion (LVI) on final pathology and core biopsy, Bloom Richardson’s score (BRS), tumor size, DCIS, DCIS grade, DCIS%, and receptor status. AXUSFNA data included number of nodes, node size and node description.
Results: Ax US FNA Sensitivity 64.9%, AxUSFNA False Negative Rate 35.1%. Smaller tumor, greater DCIS%, absent extracapsular extension, and small metastatic focus were predictive of false negative AxUSFNA. Multivariable logistic regression revealed extracapsular extension no longer significant.
Conclusions: Axillary US/FNA has a FNR of 35%, too high to omit a sentinel node biopsy in patients with a negative AxUSFNA. Remove Suspicious nodes on US and patients with LVI on core from FN cohort and FNR becomes 15%. This approaches 11% FNR seen in SLNB following neoadjuvant chemotherapy and the FNR of 10% in B-32. Correlation between LVI on final pathology and core biopsy is poor. Sensitivity was 24%. 65% had benign appearing nodes on ultrasound which 50% contained macro metastasis. Therefore, until genomic analysis supplants nodal assessment in determining adjuvant recommendation SLNB remains the most accurate tool for axillary staging.


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