The correlation of axillary ultrasonography with histologic breast cancer downstaging after induction chemotherapy

BACKGROUND: The goal of this study was to examine the role of ultrasonograp hy in detecting axillary lymph node metastases in stage II breast cancer pa tients after induction chemotherapy (IC). METHODS: Of 172 consecutive patients with T1-3, N0-1, MO breast cancer regi stered in a prospective IC trial, a subset of 130 evaluable patients were c hosen, with (1) both physical and ultrasonographic examinations of the axil la before and after IC; (2) exactly four cycles of IC; (3) no presurgical r adiation therapy; and (4) an axillary lymph node dissection. RESULTS: Before IC, 32 patients (25%) were negative for axillary involvemen t by both physical and ultrasonographic examinations. After IC, this number increased to 64 (49%). Of these, 31 (48%) were positive by pathology exami nation. In most cases, however, the residual tumor was minimal. CONCLUSIONS: Stage II breast cancer patients who were or became node negati ve by both ultrasonographic and physical examinations after IC had a 48% in cidence of nodal metastases. Because the residual tumor was minimal, irradi ation may be sufficient for adequate local control of the axilla. (C) 2000 by Excerpta Medica, Inc.