Ultrasound-guided fine needle aspiration (USFNA) of the lymph nodes is a safe, useful, and minimally invasive procedure for diagnosing metastatic disease in patients who are undergoing preoperative staging for breast cancer, according to a recent study conducted by researchers at the Rhode Island Hospital/Warren Alpert Medical School of Brown University in Providence, RI.
We wanted to determine which patients with newly diagnosed breast cancer would benefit most from preoperative fine needle aspiration of the axillary lymph nodes, said Martha Mainiero, MD, lead author of the study. This quick and minimally invasive procedure can assist the surgeon in determining what type of axillary surgery is best for patients with breast cancer. Unfortunately many centers do not routinely perform this procedure as there is not yet consensus on who will benefit from it, she said.
The study consisted of USFNA of axillary lymph nodes in 224 breast cancer patients. The researchers measured the cortical thickness of each lymph node that was aspirated. They found that using a cortical thickness measurement of 3mm to determine who gets USFNA would result in the most optimum combination of diagnosing metastatic disease preoperatively while minimizing unnecessary USFNA. Patients in the study had primary tumor sizes ranging from 0-12 cm with a mean of 1.9cm and included 159 tumors that measured less than or equal to 2 cm and 65 tumors that were greater than 2 cm. The use of USFNA was positive in 52 patients (23%). If USFNA were limited only to axillary lymph nodes with a cortical thickness of 3 mm or more, USFNA positivity would have increased to 49%.
With these results, this procedure may become more widely used and save patients unnecessary surgery, said Dr. Mainiero. This cut-off provided the most optimum combination in detecting metastatic disease while minimizing negative USFNA results, she said.
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American Roentgen Ray Society