Scientific publications

Meta-analysis of tumour burden in pre-operative axillary ultrasound positive and negative breast cancer patients

Ahmed M (1), Jozsa F (2), Baker R (3), Rubio IT (4), Benson J (5), Douek M (2).

(1) Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK.
(2) Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK.
(3) Department of Statistics, School of Business, University of Salford, 612, Maxwell Building, Salford, M5 4WT, UK.
(4) Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron 119-129, 08035, Barcelona, Spain.
(5) Breast Surgical Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.

Magazine: Breast Cancer Research Treatment

Date: Nov 1, 2017

Mammary Pathology Area

BACKGROUND:
Management of the axilla in breast cancer is becoming increasingly conservative. Patients identified with a low axillary nodal burden (two or fewer involved nodes) at sentinel node biopsy (SNB) can avoid completion axillary node clearance (cANC).

Fast track' to ANC in patients with involved nodes on pre-operative ultrasound may be over-treating a subgroup of these patients with low nodal burden, which would have precluded their need for ANC. This systematic review assesses the proportion of patients with involved nodes on pre-operative axillary ultrasound, which would fit low axillary burden criteria.

METHODS:
Meta-analysis of studies comparing axillary burden of breast cancer patients identified as pre-operative ultrasound negative versus positive was performed. The primary outcome measure was the number of patients with two or fewer involved nodes (macrometastases only). Pooled odds ratio (OR), 95% confidence intervals (CIs), means and probabilities of identifying two or fewer involved nodes versus greater than two were calculated.

RESULTS:
Six studies reported the axillary burden in 4271 patients who were either directed straight to ANC or cANC after SNB. There was a significantly greater axillary burden in the ultrasound positive versus negative groups (OR 5.95, 95% CI 5.80-6.11) with mean nodal retrieval values of 2.9 [standard error (SE) 0.2] and 1.6 (SE 0.2) nodes, respectively. Cumulative probabilities identified 78.9% of ultrasound negative and 43.2% of ultrasound positive patients possessed low axillary burden.

CONCLUSIONS:
Pre-operative ultrasound positive patients have significantly higher axillary burden. However, nearly half do fit the criteria of low axillary burden and could be considered for omission of ANC.

CITATION  Breast Cancer Res Treat. 2017 Nov;166(2):329-336. doi: 10.1007/s10549-017-4405-3. Epub 2017 Jul 28

you maybe interested

WHAT TECHNOLOGY
DO WE USE?

The Clínica is the greater private hospital with technological equipment of Spain, all in a single center.

Imagen de un PET, tecnología de vanguardia en la Clínica Universidad de Navarra

OUR
PROFESSIONALS

The professionals of the Clínica perform continuous research and training, always to the benefit of the patient.

Imagen profesionales de la Clínica Universidad de Navarra

WHY CHOOSE
THE CLINICA?

Learn why we are different from other healthcare centers. Quality, speed, comfort and results.

Imagen del edificio de la Clínica Universidad de Navarra