Does preoperative axillary staging lead to overtreatment of women with screen-detected breast cancer?
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Wallis, M., Kilburn-Toppin, F., & Taylor-Phillips, S. (2018). Does preoperative axillary staging lead to overtreatment of women with screen-detected breast cancer?. Clinical radiology, 73 (5), 467-472. https://doi.org/10.1016/j.crad.2017.11.023
Aim To determine the impact of pre-operative axillary ultrasound staging in a screen detected breast cancer population Materials and Method Ultrasound and needle biopsy staging results alongside reference standard sentinel lymph node biopsy and axillary lymph node dissection were retrospectively extracted from the unit's computer records between 01/04/2008 and 31/03/2015. Axillary staging was compared with final pathology and treatment. Results Of the 215,661 screening examinations performed, 780 invasive cancers were diagnosed which had pre-operative axillary staging data, of which 162 (20.7%) were node positive. 36 (4.6%) had a heavy nodal burden (3 or more nodes). 90 (11.5%) had an abnormal axillary ultrasound and axillary biopsy of which 54 were positive for cancer (33.3% of the node positive cases) and triaged to axillary lymph node dissection avoiding a sentinel lymph node biopsy. Of these 22 (40.7%) had neoadjuvant treatment, and 32 (59.3%) proceeded directly to axillary lymph node dissection. The sensitivity of axillary ultrasound and biopsy to detect women with a heavy nodal burden (3 or more nodes) was 41.7% (15 of 36). However, 17 (53%) of the 32 women with a positive axillary biopsy had a low burden of axillary disease (≤2 positive nodes) at axillary lymph node dissection, the mean number of nodes obtained was 14.6. Conclusion Significant numbers of women are being potentially overtreated or denied entry into Positive Sentinel Node: adjuvant therapy only vs adjuvant therapy and clearance or axillary radiotherapy (POSNOC) because of routine pre-operative axillary staging.
Axilla, Humans, Breast Neoplasms, Lymphatic Metastasis, Ultrasonography, Biopsy, Needle, Sentinel Lymph Node Biopsy, Neoplasm Staging, Sensitivity and Specificity, Retrospective Studies, Adult, Aged, Middle Aged, Female, Medical Overuse
External DOI: https://doi.org/10.1016/j.crad.2017.11.023
This record's URL: https://www.repository.cam.ac.uk/handle/1810/273211