Surgical staging of the axilla- Is it on its way out?
Association of Breast Surgery ePoster Library. Chowdhury D. 05/15/17; 166265; P022
Dr. Debkumar Chowdhury
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Abstract
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Introduction
Sentinel Lymph Node Biopsy (SLNB) is the gold standard for axillary staging in patients with negative axillary ultrasound (AUS) in early breast cancer. Surgical practices are being reviewed over the last decade under the light of ever changing new evidence leading to a more conservative approach to the axilla.
Methods
In this audit, we studied the incidence of axillary disease in patients with an ultrasound negative axilla. The selection criteria are somewhat similar to an ongoing national study- Female patients, age>50 years, primary breast lesion >1.5cm in size, ER positive and HER 2 negative. We retrospectively studied the prospectively collected data of all breast cancer patients from January 2013 to December 2015 in a population of 350,000 within NHS Ayrshire and Arran with an annual incidence of around 400 cancers.
Results
With the above patient subset taken into consideration we studied a total of 261 patients (74 cases in 2015, 118 cases in 2014 and 69 cases in 2013. The average False Negative (FN) rate with AUS per year was noted to be 10.7% over the 3 years (28 patients out 261 patients). This is well comparable to SLNB which has a FN rate of around 10%.
Conclusion
As the False Negative rate of AUS and SLNB are comparable, the former can possibly replace the latter at least in subset of early breast cancer patients. This will have significant impact on patient morbidity, theatre time and operation costs. This study fully supports a randomised trial to find this answer.
Sentinel Lymph Node Biopsy (SLNB) is the gold standard for axillary staging in patients with negative axillary ultrasound (AUS) in early breast cancer. Surgical practices are being reviewed over the last decade under the light of ever changing new evidence leading to a more conservative approach to the axilla.
Methods
In this audit, we studied the incidence of axillary disease in patients with an ultrasound negative axilla. The selection criteria are somewhat similar to an ongoing national study- Female patients, age>50 years, primary breast lesion >1.5cm in size, ER positive and HER 2 negative. We retrospectively studied the prospectively collected data of all breast cancer patients from January 2013 to December 2015 in a population of 350,000 within NHS Ayrshire and Arran with an annual incidence of around 400 cancers.
Results
With the above patient subset taken into consideration we studied a total of 261 patients (74 cases in 2015, 118 cases in 2014 and 69 cases in 2013. The average False Negative (FN) rate with AUS per year was noted to be 10.7% over the 3 years (28 patients out 261 patients). This is well comparable to SLNB which has a FN rate of around 10%.
Conclusion
As the False Negative rate of AUS and SLNB are comparable, the former can possibly replace the latter at least in subset of early breast cancer patients. This will have significant impact on patient morbidity, theatre time and operation costs. This study fully supports a randomised trial to find this answer.
Introduction
Sentinel Lymph Node Biopsy (SLNB) is the gold standard for axillary staging in patients with negative axillary ultrasound (AUS) in early breast cancer. Surgical practices are being reviewed over the last decade under the light of ever changing new evidence leading to a more conservative approach to the axilla.
Methods
In this audit, we studied the incidence of axillary disease in patients with an ultrasound negative axilla. The selection criteria are somewhat similar to an ongoing national study- Female patients, age>50 years, primary breast lesion >1.5cm in size, ER positive and HER 2 negative. We retrospectively studied the prospectively collected data of all breast cancer patients from January 2013 to December 2015 in a population of 350,000 within NHS Ayrshire and Arran with an annual incidence of around 400 cancers.
Results
With the above patient subset taken into consideration we studied a total of 261 patients (74 cases in 2015, 118 cases in 2014 and 69 cases in 2013. The average False Negative (FN) rate with AUS per year was noted to be 10.7% over the 3 years (28 patients out 261 patients). This is well comparable to SLNB which has a FN rate of around 10%.
Conclusion
As the False Negative rate of AUS and SLNB are comparable, the former can possibly replace the latter at least in subset of early breast cancer patients. This will have significant impact on patient morbidity, theatre time and operation costs. This study fully supports a randomised trial to find this answer.
Sentinel Lymph Node Biopsy (SLNB) is the gold standard for axillary staging in patients with negative axillary ultrasound (AUS) in early breast cancer. Surgical practices are being reviewed over the last decade under the light of ever changing new evidence leading to a more conservative approach to the axilla.
Methods
In this audit, we studied the incidence of axillary disease in patients with an ultrasound negative axilla. The selection criteria are somewhat similar to an ongoing national study- Female patients, age>50 years, primary breast lesion >1.5cm in size, ER positive and HER 2 negative. We retrospectively studied the prospectively collected data of all breast cancer patients from January 2013 to December 2015 in a population of 350,000 within NHS Ayrshire and Arran with an annual incidence of around 400 cancers.
Results
With the above patient subset taken into consideration we studied a total of 261 patients (74 cases in 2015, 118 cases in 2014 and 69 cases in 2013. The average False Negative (FN) rate with AUS per year was noted to be 10.7% over the 3 years (28 patients out 261 patients). This is well comparable to SLNB which has a FN rate of around 10%.
Conclusion
As the False Negative rate of AUS and SLNB are comparable, the former can possibly replace the latter at least in subset of early breast cancer patients. This will have significant impact on patient morbidity, theatre time and operation costs. This study fully supports a randomised trial to find this answer.
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