Researchers found that an ultrasound of the underarm lymph nodes before breast-conserving surgery (also called lumpectomy) spared nearly one-third of women with node-positive breast cancer from having a second surgery to remove these additional lymph nodes. These women had been diagnosed with early-stage breast cancer that had spread to the underarm lymph nodes. An axillary ultrasound uses sound waves to create a picture of the underarm lymph nodes. In this study, it was used to detect large areas of cancer cells, called macrometastases, before surgery, so that these lymph nodes could be removed at the same time as the initial breast surgery.

Once a suspicious lump has been identified as cancer, women typically have a biopsy to learn if the lump is cancerous. Once cancer is confirmed, women are scheduled for breast-conserving surgery to remove the tumor. During surgery, the doctors evaluate the lymph node where the cancer is most likely to have spread (called the sentinel node). Lymph nodes are tiny, bean-shaped organs that can act as a trap for cancer cells traveling away from the original tumor site. If the lymph node shows signs of cancer, then the surgeon removes additional nearby lymph nodes. This procedure is called a sentinel lymph node biopsy.

Sometimes, cancer cells are discovered in these additional lymph nodes after surgery, which means that women may need a second surgery to remove additional, cancerous lymph nodes, to keep the cancer from spreading to other areas of the body.

What this means for patients

“Axillary ultrasound is an accurate, low-cost procedure that should be performed routinely before surgery for women with breast cancer,” said lead author Bedanta Baruah, MD, surgical research fellow in breast cancer at the Cardiff University School of Medicine. “Regular use of this approach can provide an earlier picture of cancer spread to underarm lymph nodes and help some women avoid the trauma, costs, and anxiety associated with a second surgery.”

However, axillary ultrasound is not able to find smaller areas of cancer cells called micrometastases, so many women may still need a sentinel node biopsy. Talk with your doctors about any tests you may need before or after breast cancer surgery.

What to Ask Your Doctor

• What is the stage and grade of the breast cancer? What does this mean?
• Can the cancer be treated with surgery? If so, what type of surgery do you recommend?
• What is a sentinel lymph node biopsy? What are the benefits and risks? Do you recommend it for me?
• Is there evidence of cancer in other lymph nodes?
• Will I need a second surgery?