Ultrasound May Lead to Less Invasive Surgery in Lymph Node-Positive Breast Cancer

“Women with lymph node-positive breast cancer who demonstrate complete nodal response by axillary ultrasound after neoadjuvant chemotherapy may be able to avoid axillary dissection, according to study results.

“ ‘Our goal here is really to try to get away from, “Every patient with breast cancer needs these drugs and this amount of chemotherapy and surgery,” and instead to personalize surgical treatment based on how the patient responds to chemotherapy,’ Judy Boughey, MD, chair of the division of surgery research at Mayo Clinic in Rochester, Minnesota, said in a press release.

“The American College of Surgeons Oncology Group (ACOSOG) Z1071 trial included 687 patients with T0-4, N1-2, M0 primary invasive breast cancer. All patients completed neoadjuvant chemotherapy, underwent sentinel lymph node surgery and axillary dissection, and had axillary ultrasound images available for review.

“Previously published results indicated a 12.6% false-negative rate for sentinel lymph node surgery after neoadjuvant chemotherapy for patients who presented with node-positive disease and had two or more sentinel lymph nodes identified and removed. This false-negative rate exceeded the predetermined acceptable rate of 10%. The result suggested patient selection or technique must be improved prior to widespread adoption of sentinel lymph node surgery in this setting, according to study background…

“ ‘That’s one of the really nice things about giving chemotherapy up front,’ Boughey said. ‘It allows us to be less invasive with surgery, both in terms of breast surgery and lymph node surgery, and to tailor treatment based on response to chemotherapy.’ “