The likelihood of additional nodal disease following a positive sentinel lymph node biopsy in breast cancer patients: validation of a nomogram.

BACKGROUND: Sentinel lymph node (SLN) biopsy examination is the current modality for evaluating the axilla in breast cancer patients. A nomogram has been developed to predict the likelihood of non-SLN metastases after a positive SLN biopsy examination. The purpose of this study was to validate the nomogram in a community breast center. METHODS: A prospective database was used to identify breast cancer patients with a positive SLN biopsy examination who underwent a completion axillary lymph node dissection. The nomogram was used to calculate the probability of having non-SLN involvement, and was compared with the observed numbers. RESULTS: The observed incidence of non-SLN involvement showed excellent correlation with the nomogram predicted probability (chi-square test statistic = 5.87; P = .83). CONCLUSIONS: Predicting the risk of additional nodal metastases allows the surgeon and patient to make an individualized decision regarding the need for completion axillary lymph node dissection.

Correlation of targeted ultrasound with magnetic resonance imaging abnormalities of the breast.

BACKGROUND: Magnetic resonance imaging (MRI) of the breast is highly sensitive for cancer. However, MRI frequently detects additional lesions that mandate further evaluation. The intent of this study was to assess the ability of targeted ultrasound to identify additional lesions detected on MRI in patients undergoing evaluation for breast cancer. METHODS: Between January 1, 1999, and July 15, 2004, 270 women underwent breast MRI at Grant Medical Center. MRI was obtained in 191 women during evaluation for documented or suspected breast cancer. Fifty-two patients had additional suspicious lesions on MRI, prompting targeted ultrasound; these patients constituted our study population. RESULTS: Seventy-five additional suspicious lesions were detected on breast MRI in 52 women. Two women underwent mastectomy without targeted ultrasound. Targeted ultrasound identified 65 of the remaining 73 lesions (89%). Eight lesions (11%) were not visible on targeted ultrasound. CONCLUSION: Targeted ultrasound can be a reliable method to correlate MRI abnormalities in breast cancer patients.