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Nonsurgical Biopsy Identifies Breast Cancer

Procedure finds malignant lymph nodes without more operations

MONDAY, Nov. 29, 2004 (HealthDayNews) -- An ultrasound-guided needle biopsy is just as effective as traditional surgery in identifying malignant lymph nodes in women with breast cancer, claims a new University of Michigan study.

This means that some women diagnosed with breast cancer could avoid one of the two surgical procedures that are sometimes necessary in breast cancer treatment, some doctors say.

"We are trying to spare women an extra surgery, and it has been a positive experience for patients who can be diagnosed without surgery," said Dr. Alexis Nees, a clinical assistant professor of radiology at the University of Michigan Medical School and author of the study, which she was to present Nov. 29 at the Radiological Society of North America's annual meeting in Chicago.

Following a diagnosis of breast cancer, doctors must first assess the size and type of the tumor and then see if the cancer has spread to the lymph nodes under the arm, she explained.

The traditional way to find out if the nodes are cancerous is a surgical procedure to remove several or all of the lymph nodes in the underarm area and have a pathologist look at them to see if they are cancerous. Often, a patient is operated on for her breast tumor before the results of the lymph node biopsy can be obtained, Nees said.

If the woman chose to have only several of her lymph nodes removed, which is called a sentinel lymph node sampling, and those nodes are found to be malignant, she must then undergo a second surgery to have the rest of the lymph nodes removed.

If she had all of her lymph nodes removed, which is called axillary lymph node dissection, she obviously does not need further surgery. However, Nees said, many women choose to have the partial lymph node sampling because the axillary dissection is associated with an increased risk for other health problems.

Using ultrasound to view the lymph nodes, doctors use a fine needle to draw cells from a node that looks abnormal, and then a cytologist assesses if the cells are cancerous. Although the cytologist's assessment itself takes the same amount of time that a pathologist's reading does, results are obtained more quickly because there is no need to schedule an operating room and surgeon. Thus, the operating surgeon can get the information he or she needs before surgery about whether to remove the lymph nodes.

Ultrasound-guided fine needle biopsy is also helpful for women who undergo chemotherapy to shrink their tumor before surgery, as information about lymph node involvement means that chemotherapy treatment can include the malignant lymph nodes as well, Nees said.

However, Nees said, the technique is reliable only to confirm malignancy in the lymph nodes. If the biopsy results find no cancer or are inconclusive, the patient must then undergo a surgical procedure to make sure there is no further cancer in the lymph nodes.

"This is a helpful tool to alert doctors to a positive -- or malignant -- finding, so you can tell the surgeon and do everything in one surgery," said Dr. Jolinda Mester, an assistant clinical professor of radiology at Mount Sinai Medical Center in New York City.

For the study, researchers used ultrasound to examine 57 women newly diagnosed with breast cancer. If the lymph nodes appeared abnormal on the ultrasound, the researchers then did a needle biopsy of the nodes. The patients then had breast surgery, and either some or all of their lymph nodes were removed at the same time.

Pathology reports from the surgery were compared to the findings from the ultrasound-guided fine needle aspiration. All the women with an abnormal ultrasound and a positive biopsy were found to have cancer in their lymph nodes at surgery.

More information

The National Cancer Institute explains the different screening methods for breast cancer.

SOURCES: Alexis V. Nees, M.D., clinical assistant professor, radiology, University of Michigan Medical School, Ann Arbor; Jolinda Mester, M.D., assistant clinical professor, radiology, Mount Sinai School of Medicine, New York City; Nov. 29, 2004, presentation, Radiological Society of North America annual meeting, Chicago
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