Lloyd P, et al. - An evaluation was performed of the axillary tumour burden in women with a fine-needle aspiration/core biopsy-proven positive node on axillary ultrasonography (AUS) and in those with a positive sentinel node biopsy (SNB). Researchers identified that in comparison to those with SNB-detected metastases, patients with AUS-detected metastases had a higher axillary tumour burden. Around 40 percent of patients with AUS-detected nodal disease indicated one or two nodes with macrometastases and were thus overtreated by axillary lymph node dissection (ALND).

Methods

• Researchers undertook this retrospective cohort study of patients with early breast cancer who had AUS and ALND between 2011 and 2014.

Results

• For the study, 332 patients who had ALND were eligible; 191 (57.5 per cent) in the AUS-positive group and 141 (42.5 per cent) in the SNB-positive group.
• In the AUS-positive group, patients were older at diagnosis (P = 0·018), more frequently had larger tumours (P = 0·002), higher tumour grade (P = 0·005), positive human epidermal growth factor 2 status (P = 0·015), and negative oestrogen receptor status (P < 0·001).
• In addition, the AUS-positive group indicated a larger number of lymph nodes with macrometastases (P < 0·001) and had more frequently extranodal invasion (P < 0·001).
• 40.3 per cent of patients (77 of 191) in the AUS-positive group had only one or two nodes with macrometastases identified at histology after ALND.
• The presence of two or fewer macrometastases at ALND were associated with tumour size no larger than 20 mm, invasive ductal or lobular histology and breast-conserving surgery.
• In multiple logistic regression analysis, only tumour size and tumour histology remained significant.