Management of axillary disease.

The presence of nodal metastases is the most important prognostic indicator in breast cancer, making accurate assessment of the axillary nodal basin critical to delivering optimal therapy in breast cancer. Clinically node-negative women can be reliably staged in a minimally invasive manner using sentinel lymph node dissection (SLND). In node-negative patients receiving neoadjuvant chemotherapy, SLND can be performed after chemotherapy, allowing for a single surgical procedure and a decreased probability of requiring axillary lymph node dissection (ALND). Clinically node-positive patients are currently recommended to undergo ALND, although these recommendations may change with emerging trial data.

Effect of introducing hematoma ultrasound-guided lumpectomy in a surgical practice.

BACKGROUND: Preoperative needle localization (NL) is the gold standard for lumpectomy of nonpalpable breast cancer. Hematoma ultrasound-guided (HUG) lumpectomy can offer several advantages. The purpose of this study was to compare the use of HUG with NL lumpectomy in a single surgical practice. STUDY DESIGN: Patients with nonpalpable lesions who underwent NL or HUG lumpectomy from January 2007 to December 2009 by a single surgeon were identified from a breast surgery database. Ease of scheduling, volume excised, re-excision rates, operating room time, and health care charges were the main outcomes variables. Univariate and multivariate analyses were performed to compare the 2 groups. RESULTS: Lumpectomy was performed in 110 patients, 55 underwent HUG and 55 underwent NL. Hematoma ultrasound-guided lumpectomy was associated with a nearly 3-fold increase in the odds ratio of additional tissue being submitted to pathology (p = 0.039), but neither the total amount of breast tissue removed, nor the need for second procedure were statistically different between the 2 groups. Duration of the surgical procedure did not vary between the 2 groups; however, the time from biopsy to surgery was shorter for HUG by an expected 9.7 days (p = 0.019), implying greater ease of scheduling. Mean charges averaged $250 less for HUG than for NL, but this difference was not statistically significant. CONCLUSIONS: Hematoma ultrasound-guided is equivalent to NL with regard to volume of tissue excised, need for operative re-excision, and operating room time. Adoption of HUG in our practice allowed for more timely surgical care.