Biopsy proven axillary disease in breast cancer is a contraindication for sentinel node biopsy and is considered a predictor of heavier nodal disease. This may not hold true for early breast cancer with clinically negative axilla with a positive ultrasound biopsy. Our study aimed to identify a group of such patients with minimal involvement of 1-2 lymph nodes, who may benefit from sentinel lymph node biopsy and avoid axillary clearance based on Z11 criteria.
Ten years prospectively collected data of patients with clinically T1-2 N0 breast cancer was reviewed. All patients underwent axillary dissection for positive ultrasound biopsy. Primary outcomes were involvement of 1-2 lymph nodes or > 3 lymph nodes on final histology. Clinico-pathological and radiological factors including tumour characteristics and number of lymph nodes on ultrasound were recorded and analysed with binomial logistic regression model to predict higher lymph node disease of 3 or more lymph nodes on final histology.
One hundred and fourteen patients underwent axillary clearance for cT1-2N0 disease and positive ultrasound guided lymph node biopsy. Forty seven (41%) had only 1-2 lymph nodes positive in the final histology. None of the tested variables were found to have a predictive significance on binary logistic regression model.
It was noted that a substantial number of early breast cancer patients with ultrasound positive axillae show only 1-2 involved lymph nodes. We were unable to find any significant predictors for higher nodal disease. A larger prospective study and consideration of sentinel lymph node biopsy with ultrasound as an adjunct can be the next step forward to avoid axillary clearance in such patients.
Local Audit and Research Department.
Has not received any funding.
All authors have declared no conflicts of interest.