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Does preoperative axillary staging lead to overtreatment of women with screen detected breast cancer?
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Wallis, M. G., Kilburn-Toppin, F. and Taylor-Phillips, Sian (2018) Does preoperative axillary staging lead to overtreatment of women with screen detected breast cancer? Clinical Radiology, 73 (5). pp. 467-472. doi:10.1016/j.crad.2017.11.023 ISSN 0009-9260.
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WRAP-does-preoperative-axillary-staging-overtreatment-women-breast-Taylor-Phillips-2017.pdf - Accepted Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (2422Kb) | Preview |
Official URL: https://doi.org/10.1016/j.crad.2017.11.023
Abstract
Aim
To determine the impact of pre-operative axillary ultrasound staging in a screen detected breast cancer population
Materials and Method
Ultrasound and needle biopsy staging results alongside reference standard sentinel lymph node biopsy and axillary lymph node dissection were retrospectively extracted from the unit's computer records between 01/04/2008 and 31/03/2015. Axillary staging was compared with final pathology and treatment.
Results
Of the 215,661 screening examinations performed, 780 invasive cancers were diagnosed which had pre-operative axillary staging data, of which 162 (20.7%) were node positive. 36 (4.6%) had a heavy nodal burden (3 or more nodes). 90 (11.5%) had an abnormal axillary ultrasound and axillary biopsy of which 54 were positive for cancer (33.3% of the node positive cases) and triaged to axillary lymph node dissection avoiding a sentinel lymph node biopsy. Of these 22 (40.7%) had neoadjuvant treatment, and 32 (59.3%) proceeded directly to axillary lymph node dissection. The sensitivity of axillary ultrasound and biopsy to detect women with aheavy nodal burden (3 or more nodes) was 41.7% (15 of 36). However, 17 (53%) of the 32 women with a positive axillary biopsy had a low burden of axillary disease (≤2 positive nodes) at axillary lymph node dissection, the mean number of nodes obtained was 14.6.
Conclusion
Significant numbers of women are being potentially overtreated or denied entry into Positive Sentinel Node: adjuvant therapy only vs adjuvant therapy and clearance or axillary radiotherapy (POSNOC) because of routine pre-operative axillary staging.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) |
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Library of Congress Subject Headings (LCSH): | Breast -- Cancer -- Diagnosis, Breast -- Cancer -- Treatment | ||||||||
Journal or Publication Title: | Clinical Radiology | ||||||||
Publisher: | W.B. Saunders Co. Ltd. | ||||||||
ISSN: | 0009-9260 | ||||||||
Official Date: | May 2018 | ||||||||
Dates: |
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Volume: | 73 | ||||||||
Number: | 5 | ||||||||
Page Range: | pp. 467-472 | ||||||||
DOI: | 10.1016/j.crad.2017.11.023 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 22 November 2017 | ||||||||
Date of first compliant Open Access: | 27 December 2018 | ||||||||
RIOXX Funder/Project Grant: |
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