Pre-operative and intra-operative detectionof axillary lymph node metastases in 108patients with invasive lobular breast cancerundergoing mastectomy

RESEARCH ARTICLEOpen AccessPre-operative and intra-operative detectionof axillary lymph node metastases in 108patients with invasive lobular breast cancerundergoing mastectomyJerica Novak1*, Nikola Besic1, Radan Dzodic2, Barbara Gazic3and Andrej Vogrin4AbstractBackground:Despite the recent changes in the treatment of the axilla in selected breast cancer patient, positivesentinel lymph node (SLN) in patients undergoing mastectomy still necessitates axillary lymph node dissection (ALND).In invasive lobular carcinoma (ILC), pre-operative detection of the lymph node metastasis may be demanding due toits unique morphology. The aim of this study was to examine the benefit of preoperative axillary ultrasound (AUS),ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and intra-operative imprint cytology (IIC), in order to avoidtwo-stage axillary surgery in patients with ILC undergoing mastectomy.Methods:The object of this study were 102 patients (median age 52, range 34–73 years) with clinically non-suspiciousaxilla in whom 108 mastectomies were performed after a pre-operative AUS investigation. Whenever a metastasis wasdetected in a sentinel lymph node, ALND was done. Reports of the pre-operative AUS investigation, US-FNAB, and IICwere compared with definitive histopathological reports of surgical specimens.Results:In 46 cases lymph node metastases were diagnosed. AUS suspicious lymph nodes were found in 29/108 casesand histopathology confirmed metastases in 22/30 cases. US-FNAB was performed in 29 cases with AUS suspiciouslymph nodes. Cytology proved metastases in 11/29 cases. Histopathology confirmed metastases in 10/11 cases withonly isolated tumor cells found in one case. IIC investigation was performed in 63 cases and in 10/27 cases metastaseswere confirmed by histopathology. Pre-operative AUS, US-FNAB, and/or IIC investigation enabled ALND during a singlesurgical procedure in 20/46 patients with metastases in lymph nodes.Conclusion:Pre-operative AUS, US-FNAB, and/or IIC are/is beneficial in patients with ILC planned for mastectomy inorder to decrease the number of two stage axillary procedures.Keywords:Invasive lobular carcinoma, Axillary lymph node metastasis, Axillary ultrasound, Ultrasound-guided fine-needle aspiration biopsy, Intra-operative imprint cytology.