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The Z0011 Trial: Is this the end of axillary ultrasound in the pre-operative assessment of breast cancer patients?

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Abstract

Objectives

The Z0011 trial questioned the role of axillary ultrasound (AxUS) in preoperative staging of breast cancer in patients with ≤2 positive sentinel lymph nodes (SLN). The purpose of this study was to correlate the number of abnormal nodes on AxUS with final nodal burden and determine the utility of AxUS with sampling (AxUS + S) in preoperative staging.

Methods

Six hundred and seventy-nine patients underwent pre-operative AxUS. Suspicious nodes were sampled. Negative axillae proceeded to SLN biopsy. The number of abnormal nodes identified on ultrasound and final histology as well as sensitivity and specificity for AxUS + S were calculated. Subgroup analysis was performed on Z0011 eligible patients.

Results

Two hundred and ninety-six patients had positive axillary nodes on final histology with 169 detected by AxUS + S (sensitivity 86.2 %, specificity 100 %, PPV 100 %, NPV 71.9 %). Patients with nodal metastases identified by AxUS had a mean burden of 7.3 nodes on histology (1 node on AxUS = 5.2 nodes on histology, 2 nodes on AxUS = 7.5 nodes, >2 nodes = 10.1 nodes). Patients diagnosed on SLNB had a mean burden of 2.2 nodes.

Conclusion

A single nodal metastasis detected on AxUS + S correlated with a mean of 5.2 nodes on final histology highlighting that AxUS remains essential in guiding appropriate management of the axilla in breast cancer.

Key Points

• Axillary ultrasound +/- sampling is an essential technique in preoperative axillary staging.

• Axillary ultrasound findings correlate with final histological axillary node disease burden.

• Axillary ultrasound can help triage patients who require axillary lymph node dissection.

• The role of axillary ultrasound in breast cancer staging continues to evolve.

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Abbreviations

SLNB:

Sentinel lymph node biopsy

PPV:

Positive predictive value

NPV:

Negative predictive value

ALND:

axillary lymph node dissection

AxUS:

axillary ultrasound

FNAC:

Fine needle aspiration cytology

CB:

Core biopsy

Ax-US + S:

axillary ultrasound + sampling (FNAC or CB)

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Acknowledgements

The scientific guarantor of this publication is Dr Sylvia O’Keeffe. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because of the retrospective nature of this study. This is a retrospective observational study performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, St James’s Hospital, Dublin 8, Ireland

    T. P. J. Farrell, N. C. Adams, M. Stenson & S. A. O’Keeffe

  2. Department of Surgery, St James’s Hospital, Dublin 8, Ireland

    P. A. Carroll & E. M. Connolly

  3. Department of Pathology, St James’s Hospital, Dublin 8, Ireland

    M. Griffin

Authors
  1. T. P. J. Farrell
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  2. N. C. Adams
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  3. M. Stenson
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  4. P. A. Carroll
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  5. M. Griffin
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  6. E. M. Connolly
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  7. S. A. O’Keeffe
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Corresponding author

Correspondence to T. P. J. Farrell.

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Farrell, T.P.J., Adams, N.C., Stenson, M. et al. The Z0011 Trial: Is this the end of axillary ultrasound in the pre-operative assessment of breast cancer patients?. Eur Radiol 25, 2682–2687 (2015). https://doi.org/10.1007/s00330-015-3683-6

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  • DOI: https://doi.org/10.1007/s00330-015-3683-6

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