Objectives: To evaluate peri-lymph nodal pathological fibrosis in axillar surgical specimens of breast cancer patients submitted to 14G percutaneous fragment biopsy (PFB) of axillary sentinel lymph node identified with contrast-enhanced ultrasonography (C
Peri-lymph nodal pathological fibrosis and axillary surgical impairment after 14G percutaneous fragment biopsy of sentinel
lymph node detected with contrast-enhanced ultrasonography (CEUS) in early breast cancer patients.
Nicoli Serquiz, Carlos A. Menossi, Natalie R. Almeida, Gabrielle Baccarin, Geisilene R. P. Silva, Luciano Moro, Sophie
Derchain, Rodrigo M. Jales
Women’s Hospital “Prof. Dr. José Aristodemo Pinotti” of State University of Campinas – CAISM/UNICAMP
Abstract
Objectives: To evaluate peri-lymph nodal pathological fibrosis in axillar surgical specimens of breast cancer patients
submitted to 14G percutaneous fragment biopsy (PFB) of axillary sentinel lymph node identified with contrast-enhanced
ultrasonography (CEUS) Methods: This study was originally designed to assess the performance of CEUS+PFB on the
axillary staging of early-stage breast cancer. The selection of participants was interrupted, and the design was reformulated to
this descriptive cross-sectional study after unexpected peri-lymph nodal pathological fibrosis reported in axillary surgery
specimens. The frequency or means of the main clinical, ultrasonographic, surgical and pathological characteristics were
calculated. T-test or Pearson Chi-Square test compared the groups of patients with and without peri-lymph nodal pathological
fibrosis. Results: Forty-eight patients submitted to CEUS+PFB and axillary surgery were eligible for this study. Axillary
surgical specimens showed peri-lymph nodal fibrosis in 9/48 (18.7%) patients. The majority of peri-lymph nodal fibrosis were
described as moderate (4/9(44.4%)) or severe (4/9(44.4%)). There was no significant difference between groups regarding
patient age (p=0.99), breast tumor size (p=0.60), rate of lymph-node metastasis (p=0.83), use of aromatase inhibitor (p=0.43),
number of intradermal contrast injection (p=0.68), CEUS sentinel lymph identification (p=0.10), and CEUS sentinel lymph
node mean maximum diameter (p=0.24). Axillary surgical impairment or hematoma were only reported in patients with
axillary peri-lymph nodal fibrosis (p<0.001 and p=0.003, respectively). Mean time between CEUS+PFB and axillary surgery
was shorter (p=0.04) in patients with peri-lymph nodal fibrosis. Conclusion Peri-lymph nodal pathological fibrosis may impair
the axillary surgical procedure of early breast cancer patients staged with CEUS+PFB.
Keywords: breast cancer; axillary staging, contrast-enhanced ultrasound (CEUS); microbubble contrast; sentinel lymph node.