Ultrasound for axillary staging
Journal
Personalized Treatment of Breast Cancer
Pages
77-91
Date Issued
2016
Author(s)
Abstract
Ultrasound examination of the axillary lymph node has been demonstrated to be a useful tool in evaluating axilla lymph node status. Axillary ultrasound (AUS) was first used to identify positive lymph nodes preoperatively, so that patients could undergo axillary lymph node dissection (ALND) directly and be spared from sentinel lymph node biopsy (SLNB). Recent studies also focus on the application of AUS in surgical planning when AUS reveals negative nodal status. When AUS is negative, the chance of having more than three positive nodes is low. Therefore, when AUS is negative, one can plan immediate reconstruction after mastectomy, and there is no need of intraoperative SLN examination for breastconserving surgery. If AUS reveals suspicious lymph node and ultrasound-guided biopsy proves the node to be metastatic, SLNB can be spared if mastectomy is planned. Axillary ultrasound is also helpful in guiding whether SLNB should be done before or after neoadjuvant chemotherapy. If AUS is negative, the chance of having positive SLN is relatively low, and it would be reasonable to proceed with SLNB. If AUS or ultrasound-guided biopsy is positive, one may consider SLNB after neoadjuvant chemotherapy. For node-positive patients undergoing neoadjuvant chemotherapy first, patients with negative AUS before SLNB can be considered to undergo SLNB alone after neoadjuvant chemotherapy.
Publisher
Springer Japan
Type
book part