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Examining the false-negative rate of a negative axillary node ultrasound-guided core needle biopsy in breast cancer patients undergoing upfront surgery. Am J Surg 2025 Jan;239:116047

Date

11/01/2024

Pubmed ID

39481279

Pubmed Central ID

PMC11650375

DOI

10.1016/j.amjsurg.2024.116047

Scopus ID

2-s2.0-85207766054 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: Axillary assessment in breast cancer is key to determining an upfront surgery or neoadjuvant chemotherapy (NAC) approach. We investigated the false-negative rate (FNR) of axillary-node ultrasound-guided core-needle biopsy (US-CNBx) and the surgical management of pN ​+ ​patients.

METHODS: This single-institution study from 2010 to 2020 included patients with benign findings on US-CNBx and upfront surgery. Statistical analyses were performed via t-tests and chi-squared tests.

RESULTS: 95 axillae met inclusion, 23 were pN+, resulting in a US-CNBx FNR of 24.2 ​%. pN ​+ ​patients more frequently had cT2-T3 tumors vs pN0 patients (43.5 ​% vs 27.8 ​%, p ​= ​0.03). Of the 23 ​pN ​+ ​patients, 9 underwent breast-conserving surgery (BCS) and 14 underwent mastectomy. In those with BCS, 7 had 1-2 positive nodes, 2 had ≥3 nodes; 3 received an ALND. In those with mastectomies, 12 had 1-2 positive nodes, 2 had ≥3 positive nodes; 6 received an ALND.

CONCLUSION: In this cohort, US-CNBx had a FNR of 24.2 ​%. pN ​+ ​patients had a greater frequency of cT2-cT3 tumors, therefore clinicians should be cognizant of potential occult nodal disease despite negative CNBx when deciding management.

Author List

Rogers C, Zeien S, Puccetti K, Jorns JM, Kong AL, Cherian S, Cortina CS

Authors

Solomon Cherian MD Associate Professor in the Radiology department at Medical College of Wisconsin
Chandler S. Cortina MD Associate Professor in the Surgery department at Medical College of Wisconsin
Julie M. Jorns MD Professor in the Pathology department at Medical College of Wisconsin
Amanda L. Kong MD, MS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Axilla
Biopsy, Large-Core Needle
Breast Neoplasms
False Negative Reactions
Female
Humans
Image-Guided Biopsy
Lymph Node Excision
Lymph Nodes
Lymphatic Metastasis
Mastectomy
Middle Aged
Retrospective Studies
Sentinel Lymph Node Biopsy
Ultrasonography, Interventional