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Vol 3, No 2 (2018)
Original article
Published online: 2018-07-31
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Role of axillary ultrasound in the evaluation of early breast cancer in the era of Z0011: Time to redefine?

Abdul Syed1, Sudhakar Eleti1, Asha Eleti1
·
Medical Research Journal 2018;3(2):82-88.
Affiliations
  1. Southend University Hospital, Prittlewell Chase, SS0 0RY Southend on Sea, United Kingdom

open access

Vol 3, No 2 (2018)
ORIGINAL ARTICLES
Published online: 2018-07-31

Abstract

Introduction: Ultrasound with concurrent histology of abnormal axillary lymph nodes has revolutionized the

treatment of patients with breast cancer. By identifying nodal metastases, patients can avoid a two-stage

axillary procedure. However, the results of the American College of Surgeons Oncology Group Z0011 trial

indicate that a certain group of patients may have been over-treated with axillary dissection. Our aim was

to analyze the nodal burden of patients identified by axillary ultrasound and to determine the proportion

of patients who could have foregone axillary dissection incorporating Z0011 trial.

Methods: A retrospective analysis of patients with diagnosed breast cancer who underwent direct axillary

dissection was performed. Based on nodal metastases patients were categorized into ‘extensive’ and

‘minimal’ groups and studied. Demographics and tumor characteristics were analyzed and eligibility for

the Z0011 study was determined.

 

Results: All 1745 patients diagnosed with breast cancer underwent axillary ultrasound from April 2009 to

March 2015. Of these, 197 patients had histology-proven nodal metastases and underwent direct axillary

lymph node dissection. One hundred and twenty-one patients (61.4%) had extensive and 76 patients

(38.6%) had minimal nodal metastases. Of the latter, 23 patients (11.7%) fulfilled the Z0011 criteria.

Conclusion: This study demonstrated that a large proportion of patients had minimal nodal involvement

(38.6%), in contrast to the results published in the literature. In addition, a significant number of patients

could have avoided axillary dissection (11.7%) based on the Z0011 criteria. Hence our study encourages

to redefine the role of axillary ultrasound to avoid unnecessary axillary dissection.

Key points:

  1. Axillary ultrasound is performed in all patients diagnosed with breast cancer.
  2. Axillary ultrasound findings do not correlate with histological burden of nodal disease.
  3. Role of axillary ultrasound needs to be redefined to avoid unnecessary axillary dissection.

Abstract

Introduction: Ultrasound with concurrent histology of abnormal axillary lymph nodes has revolutionized the

treatment of patients with breast cancer. By identifying nodal metastases, patients can avoid a two-stage

axillary procedure. However, the results of the American College of Surgeons Oncology Group Z0011 trial

indicate that a certain group of patients may have been over-treated with axillary dissection. Our aim was

to analyze the nodal burden of patients identified by axillary ultrasound and to determine the proportion

of patients who could have foregone axillary dissection incorporating Z0011 trial.

Methods: A retrospective analysis of patients with diagnosed breast cancer who underwent direct axillary

dissection was performed. Based on nodal metastases patients were categorized into ‘extensive’ and

‘minimal’ groups and studied. Demographics and tumor characteristics were analyzed and eligibility for

the Z0011 study was determined.

 

Results: All 1745 patients diagnosed with breast cancer underwent axillary ultrasound from April 2009 to

March 2015. Of these, 197 patients had histology-proven nodal metastases and underwent direct axillary

lymph node dissection. One hundred and twenty-one patients (61.4%) had extensive and 76 patients

(38.6%) had minimal nodal metastases. Of the latter, 23 patients (11.7%) fulfilled the Z0011 criteria.

Conclusion: This study demonstrated that a large proportion of patients had minimal nodal involvement

(38.6%), in contrast to the results published in the literature. In addition, a significant number of patients

could have avoided axillary dissection (11.7%) based on the Z0011 criteria. Hence our study encourages

to redefine the role of axillary ultrasound to avoid unnecessary axillary dissection.

Key points:

  1. Axillary ultrasound is performed in all patients diagnosed with breast cancer.
  2. Axillary ultrasound findings do not correlate with histological burden of nodal disease.
  3. Role of axillary ultrasound needs to be redefined to avoid unnecessary axillary dissection.
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Keywords

Ultrasonography; Cytology; Metastasis; Breast Cancer; Lymph nodes

About this article
Title

Role of axillary ultrasound in the evaluation of early breast cancer in the era of Z0011: Time to redefine?

Journal

Medical Research Journal

Issue

Vol 3, No 2 (2018)

Article type

Original article

Pages

82-88

Published online

2018-07-31

Page views

668

Article views/downloads

776

DOI

10.5603/MRJ.2018.0014

Bibliographic record

Medical Research Journal 2018;3(2):82-88.

Keywords

Ultrasonography
Cytology
Metastasis
Breast Cancer
Lymph nodes

Authors

Abdul Syed
Sudhakar Eleti
Asha Eleti

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