Does preoperative axillary staging lead to overtreatment of women with screen detected breast cancer?

Aim To determine the impact of pre-operative axillary ultrasound staging in a screen detected breast cancer population Materials and Method Ultrasound and needle biopsy staging results alongside reference standard sentinel lymph node biopsy and axillary lymph node dissection were retrospectively extracted from the unit's computer records between 01/04/2008 and 31/03/2015. Axillary staging was compared with final pathology and treatment. Results Of the 215,661 screening examinations performed, 780 invasive cancers were diagnosed which had pre-operative axillary staging data, of which 162 (20.7%) were node positive. 36 (4.6%) had a heavy nodal burden (3 or more nodes). 90 (11.5%) had an abnormal axillary ultrasound and axillary biopsy of which 54 were positive for cancer (33.3% of the node positive cases) and triaged to axillary lymph node dissection avoiding a sentinel lymph node biopsy. Of these 22 (40.7%) had neoadjuvant treatment, and 32 (59.3%) proceeded directly to axillary lymph node dissection. The sensitivity of axillary ultrasound and biopsy to detect women with aheavy nodal burden (3 or more nodes) was 41.7% (15 of 36). However, 17 (53%) of the 32 women with a positive axillary biopsy had a low burden of axillary disease (≤2 positive nodes) at axillary lymph node dissection, the mean number of nodes obtained was 14.6. Conclusion Significant numbers of women are being potentially overtreated or denied entry into Positive Sentinel Node: adjuvant therapy only vs adjuvant therapy and clearance or axillary radiotherapy (POSNOC) because of routine pre-operative axillary staging

Does preoperative axillary staging lead to overtreatment of women with screen-detected breast cancer?

AIM: To determine the impact of preoperative axillary ultrasound staging in a screen-detected breast cancer population. MATERIALS AND METHODS: Ultrasound and needle biopsy staging results alongside reference standard sentinel lymph node biopsy and axillary lymph node dissection were extracted retrospectively from the unit's computer records between 1 April 2008 and 31 March 2015. Axillary staging was compared with final histopathology and treatment. RESULTS: Of the 215,661 screening examinations performed, 780 invasive cancers were diagnosed, which had preoperative axillary staging data, of which 162 (20.7%) were node positive. Thirty-six (4.6%) had a heavy nodal burden (three or more nodes). Ninety (11.5%) had an abnormal axillary ultrasound and axillary biopsy of which 54 were positive for cancer (33.3% of the node positive cases) and triaged to axillary lymph node dissection avoiding a sentinel lymph node biopsy. Of these 22 (40.7%) had neoadjuvant treatment, and 32 (59.3%) proceeded directly to axillary lymph node dissection. The sensitivity of axillary ultrasound and biopsy to detect women with a heavy nodal burden (three or more nodes) was 41.7% (15 of 36); however, 17 (53%) of the 32 women with a positive axillary biopsy had a low burden of axillary disease (two or fewer positive nodes) at axillary lymph node dissection, the mean number of nodes obtained was 14.6. CONCLUSION: Significant numbers of women are being potentially overtreated or denied entry into positive sentinel node: adjuvant therapy only versus adjuvant therapy and clearance or axillary radiotherapy (POSNOC) because of routine preoperative axillary staging

Introduction of an abbreviated breast MRI service in the UK as part of the BRAID trial: practicalities, challenges, and future directions.

Abstract Introduction Women with mammographically dense breasts have an increased risk of breast cancer. Dense breasts can limit detection of small breast lesions due to overlapping fibroglandular tissue. BRAID is a randomised, multi-centre UK study assessing the impact of supplementary imaging, including abbreviated breast MRI (ABB-MRI), in detection of breast cancer in women aged 50-70 years with dense breasts. ABB-MRI is a shorter protocol breast MRI, allowing much faster acquisition times. The aim of this study is to review the feasibility of introducing ABB-MRI into the NHS setting as a part of a research trial. Protocol ABB-MRI is performed on a 1.5 tesla MRI scanner. Sequences obtained include a 2 mm axial T2 weighted sequence, a dual echo (Dixon water/fat separation) 3D DCE acquisition consisting of one pre- and two post-contrast images with generation of post-contrast subtracted images and post-processed MIP images. Scheduling ABB-MRIs are performed on a dedicated breast MRI list. Participants arrive 30 minutes prior to appointment time with pre-filled safety questionnaire. ABB-MRIs are scheduled for a 20-minute appointment slot, allowing 10 women to be scanned in a 3-hour session. Specific roles are allocated to staff members. Improving Efficiency of ABB-MRI in the UK Challenges encountered are similar to those encountered with FDP: IV cannulation, BMI and claustrophobia. Dedicated MR sessions with standard contrast doses and prefilled safety questionnaires help improve efficiency of sessions and allow examination times under 15 minutes.GE Healthcare NIHR Senior Investigator Awar

Axillary lymphadenopathy at the time of COVID-19 vaccination: ten recommendations from the European Society of Breast Imaging (EUSOBI)

Unilateral axillary lymphadenopathy is a frequent mild side effect of COVID-19 vaccination. European Society of Breast Imaging (EUSOBI) proposes ten recommendations to standardise its management and reduce unnecessary additional imaging and invasive procedures: (1) in patients with previous history of breast cancer, vaccination should be performed in the contralateral arm or in the thigh; (2) collect vaccination data for all patients referred to breast imaging services, including patients undergoing breast cancer staging and follow-up imaging examinations; (3) perform breast imaging examinations preferentially before vaccination or at least 12 weeks after the last vaccine dose; (4) in patients with newly diagnosed breast cancer, apply standard imaging protocols regardless of vaccination status; (5) in any case of symptomatic or imaging-detected axillary lymphadenopathy before vaccination or at least 12 weeks after, examine with appropriate imaging the contralateral axilla and both breasts to exclude malignancy; (6) in case of axillary lymphadenopathy contralateral to the vaccination side, perform standard work-up; (7) in patients without breast cancer history and no suspicious breast imaging findings, lymphadenopathy only ipsilateral to the vaccination side within 12 weeks after vaccination can be considered benign or probably-benign, depending on clinical context; (8) in patients without breast cancer history, post-vaccination lymphadenopathy coupled with suspicious breast finding requires standard work-up, including biopsy when appropriate; (9) in patients with breast cancer history, interpret and manage post-vaccination lymphadenopathy considering the timeframe from vaccination and overall nodal metastatic risk; (10) complex or unclear cases should be managed by the multidisciplinary team