Breast Cancer News:

Study: New Biopsy Technique May Spare Breast Cancer Patients Additional Surgery

A new biopsy technique can help doctors determine when breast cancer has invaded the lymph nodes, sparing some women additional surgery, according to a study presented November 29 at the Radiological Society of North America’s annual meeting in Chicago.

The technique uses ultrasound along with a fine needle biopsy. The University of Michigan Medical School researchers who developed the technique say it is a reliable way of determining whether the lymph nodes are malignant.

Traditional ways of determining cancer’s spread to the axilla, or underarm, are sentinel lymph node sampling, in which the first lymph node is identified and assessed for cancerous cells, or axillary lymph node dissection, in which all the lymph nodes in the underarm are removed and examined for cancer. If the sentinel node biopsy shows cancer, then a patient needs to return to the operating room to have the lymph nodes removed.

The technique uses ultrasound to identify the axillary lymph nodes and determine if their appearance is normal or abnormal. If they look abnormal, a small 22-gauge needle is inserted into the node to extract cells that can be evaluated for cancer. It requires only local anesthesia and involves no surgical incisions. Both sentinel lymph node sampling and axillary node dissection are full surgical procedures.

The researchers used ultrasound to examine 57 women newly diagnosed with breast cancer. If the lymph nodes appeared abnormal on the ultrasound, the researchers performed a fine needle aspiration, using ultrasound to guide the biopsy. Patients then had breast surgery and either sentinel lymph node sampling or axillary node dissection.

Pathology reports from surgery were compared to results from the ultrasound-guided fine needle aspiration. Of the women whose ultrasound showed abnormal lymph nodes, 92.8 percent had cancerous nodes at surgery. And, the researchers found, all the women with an abnormal ultrasound and a positive biopsy were found to have cancer in their lymph nodes at surgery.

“Both those numbers are extremely high,” said researcher Alexis Nees, M.D., clinical assistant professor of radiology. “This tells us that axillary ultrasound combined with ultrasound guided fine needle aspiration of abnormal lymph nodes can identify some patients with cancer in their lymph nodes. These patients can proceed with chemotherapy or definitive surgery and be spared an additional surgical procedure.”

Nees notes the technique is not reliable to rule out the cancer’s spread; it can only confirm positive lymph nodes. Because of that, if the test comes back negative, sentinel lymph node sampling would still be necessary. The University of Michigan Comprehensive Cancer Center offers the ultrasound and fine needle biopsy to all appropriate patients.

Source: Medical Week staff, week of Novmeber 27, 2004