Pre-operative axillary assessment - how reliable is it?
Association of Breast Surgery ePoster Library. Court F. 05/15/17; 166290; P071
Ms. Fiona Court
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Abstract
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Introduction. Pre-operative axillary USS for assessment of axillary disease in breast cancer is routine. USS is a dynamic, user dependent modality of imaging. Reported sensitivity for the detection of axillary metastases ranges from 54.1 % to 68.2% and the sensitivity of ultrasound guided FNAC/biopsy ranges from 28.5 % to 55.6%. Increased reliance on pre-operative imaging assessment of the axilla and the introduction of trials relying on imaging without surgery have been introduced.
Methods. All symptomatic and screening cancers undergoing ANC (≥ macromets) during a 12 month period in 2015 were audited. The patient notes, radiology and pathology results were used to assess which patients underwent pre-operative axillary USS assessment and/or biopsy/FNAC. An RCR audit template was used stating standards of 50% sensitivity for imaging and 50% sensitivity for biopsy.
Results. 99 patients undergoing ANC were identified (76 symptomatic cancers, 23 screen detected cancers). 49% patients had Gr2 cancer, 32% patients had Gr3 cancer. 13% had invasive lobular cancer (imaging sensitivity = 40%). Imaging sensitivity variability= 45-90%. Biopsy sensitivity variability= 39%-86%.28% (9/32) patients with ≥ 4 positive nodes had a negative USS. Range of positive lymph nodes at ANC = 1-25 (mean 4, median 2). Range of positive lymph nodes at ANC in image negative patients = 1-25 (mean 4, median 2).
Conclusion. Pre-operative axillary assessment with USS and biopsy is user dependent and highly variable and cannot always be relied upon to exclude axillary disease. Even patients with multiple positive lymph nodes may not be identified on USS alone.
Methods. All symptomatic and screening cancers undergoing ANC (≥ macromets) during a 12 month period in 2015 were audited. The patient notes, radiology and pathology results were used to assess which patients underwent pre-operative axillary USS assessment and/or biopsy/FNAC. An RCR audit template was used stating standards of 50% sensitivity for imaging and 50% sensitivity for biopsy.
Results. 99 patients undergoing ANC were identified (76 symptomatic cancers, 23 screen detected cancers). 49% patients had Gr2 cancer, 32% patients had Gr3 cancer. 13% had invasive lobular cancer (imaging sensitivity = 40%). Imaging sensitivity variability= 45-90%. Biopsy sensitivity variability= 39%-86%.28% (9/32) patients with ≥ 4 positive nodes had a negative USS. Range of positive lymph nodes at ANC = 1-25 (mean 4, median 2). Range of positive lymph nodes at ANC in image negative patients = 1-25 (mean 4, median 2).
Conclusion. Pre-operative axillary assessment with USS and biopsy is user dependent and highly variable and cannot always be relied upon to exclude axillary disease. Even patients with multiple positive lymph nodes may not be identified on USS alone.
Introduction. Pre-operative axillary USS for assessment of axillary disease in breast cancer is routine. USS is a dynamic, user dependent modality of imaging. Reported sensitivity for the detection of axillary metastases ranges from 54.1 % to 68.2% and the sensitivity of ultrasound guided FNAC/biopsy ranges from 28.5 % to 55.6%. Increased reliance on pre-operative imaging assessment of the axilla and the introduction of trials relying on imaging without surgery have been introduced.
Methods. All symptomatic and screening cancers undergoing ANC (≥ macromets) during a 12 month period in 2015 were audited. The patient notes, radiology and pathology results were used to assess which patients underwent pre-operative axillary USS assessment and/or biopsy/FNAC. An RCR audit template was used stating standards of 50% sensitivity for imaging and 50% sensitivity for biopsy.
Results. 99 patients undergoing ANC were identified (76 symptomatic cancers, 23 screen detected cancers). 49% patients had Gr2 cancer, 32% patients had Gr3 cancer. 13% had invasive lobular cancer (imaging sensitivity = 40%). Imaging sensitivity variability= 45-90%. Biopsy sensitivity variability= 39%-86%.28% (9/32) patients with ≥ 4 positive nodes had a negative USS. Range of positive lymph nodes at ANC = 1-25 (mean 4, median 2). Range of positive lymph nodes at ANC in image negative patients = 1-25 (mean 4, median 2).
Conclusion. Pre-operative axillary assessment with USS and biopsy is user dependent and highly variable and cannot always be relied upon to exclude axillary disease. Even patients with multiple positive lymph nodes may not be identified on USS alone.
Methods. All symptomatic and screening cancers undergoing ANC (≥ macromets) during a 12 month period in 2015 were audited. The patient notes, radiology and pathology results were used to assess which patients underwent pre-operative axillary USS assessment and/or biopsy/FNAC. An RCR audit template was used stating standards of 50% sensitivity for imaging and 50% sensitivity for biopsy.
Results. 99 patients undergoing ANC were identified (76 symptomatic cancers, 23 screen detected cancers). 49% patients had Gr2 cancer, 32% patients had Gr3 cancer. 13% had invasive lobular cancer (imaging sensitivity = 40%). Imaging sensitivity variability= 45-90%. Biopsy sensitivity variability= 39%-86%.28% (9/32) patients with ≥ 4 positive nodes had a negative USS. Range of positive lymph nodes at ANC = 1-25 (mean 4, median 2). Range of positive lymph nodes at ANC in image negative patients = 1-25 (mean 4, median 2).
Conclusion. Pre-operative axillary assessment with USS and biopsy is user dependent and highly variable and cannot always be relied upon to exclude axillary disease. Even patients with multiple positive lymph nodes may not be identified on USS alone.
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