The combination of ultrasound and find needle biopsy can reliably identify malignant lymph nodes in women with breast cancer, allowing some patients to avoid an additional surgical procedure, according to a presentation at the annual meeting of the Radiological Society of North America.

For some breast cancer patients, chemotherapy may be necessary before surgery. For these women, it is important to establish whether disease has spread to the lymph nodes before chemotherapy begins. Rather than undergo a sentinel lymph node sampling surgical procedure, doctors can use ultrasound-guided fine needle aspiration to confirm lymph-node disease without surgery.

“The goal of the study was to use ultrasound to preoperatively assess the axillary lymph nodes. If we can use ultrasound to stage the axilla and identify metastatic disease, we can save some women the additional surgery,” said Alexis Nees, MD, study presenter.

In the current work, researchers used ultrasound with 57 women newly diagnosed with breast cancer to identify the axillary lymph nodes and determine if their appearance was normal or abnormal. If they looked abnormal, a small 22-gauge needle was inserted into the node to extract a specimen for pathological analysis. The technique required only local anesthesia. Both sentinel lymph node sampling and axillary node dissection are full surgical procedures.

Patients with positive nodes using the combination technique then had breast surgery and either sentinel lymph node sampling or axillary node dissection.
Pathology reports from surgery were compared with results from the ultrasound-guided fine needle aspiration. Of the women whose ultrasound showed abnormal lymph nodes, 92.8 percent had cancerous nodes at surgery. Furthermore, all women with an abnormal ultrasound and a positive biopsy were found to have cancer in their lymph nodes at surgery.

“Both those numbers are extremely high,” said Nees. “This tells us that axillary ultrasound combined with ultrasound-guided fine needle aspiration of abnormal lymph nodes can identify some patients with cancer in their lymph nodes. These patients can proceed with chemotherapy or definitive surgery and be spared an additional surgical procedure.”

Nees emphasized the technique is not reliable to rule out spread of disease; it can only confirm positive lymph nodes. Because of that, if the test comes back negative, sentinel lymph node sampling is still necessary.