Dual role of intraoperative ultrasound in axillary surgery: enhanced detection and surgical de-escalation in breast cancer.
[BACKGROUND] Intraoperative ultrasound (IO-USG) may optimize axillary management in breast cancer surgery.
- 추적기간 33.2 months
- 연구 설계 cohort study
APA
Gündoğdu A, Aktaş M, et al. (2026). Dual role of intraoperative ultrasound in axillary surgery: enhanced detection and surgical de-escalation in breast cancer.. World journal of surgical oncology, 24(1). https://doi.org/10.1186/s12957-026-04223-8
MLA
Gündoğdu A, et al.. "Dual role of intraoperative ultrasound in axillary surgery: enhanced detection and surgical de-escalation in breast cancer.." World journal of surgical oncology, vol. 24, no. 1, 2026.
PMID
41606609
Abstract
[BACKGROUND] Intraoperative ultrasound (IO-USG) may optimize axillary management in breast cancer surgery. This study evaluated IO-USG’s dual role in preventing unnecessary axillary lymph node dissection (ALND) and identifying additional nodal metastases missed by sentinel lymph node biopsy (SLNB).
[METHODS] This retrospective cohort study included 314 consecutive patients with invasive breast cancer who underwent SLNB with IO-USG evaluation between January 2019 and December 2023. IO-USG was performed after SLNB to identify suspicious non-sentinel nodes. Patients were categorized into SLNB-only, targeted axillary dissection (TAD), or ALND based on combined SLNB and IO-USG findings.
[RESULTS] Of 314 patients, 113 (36%) received neoadjuvant chemotherapy and 201 (64%) underwent upfront surgery. Final surgical management comprised SLNB-only in 244 (77.7%), TAD in 46 (14.7%), and ALND in 24 (7.6%) patients. Among 89 SLNB-positive patients, 68 (76.4%) avoided ALND through IO-USG guidance. IO-USG identified additional axillary metastases in 4 of 225 SLNB-negative patients (1.8%). Molecular subtype analysis revealed no IO-USG positivity in triple-negative cases (0/25), while HR+/HER2- tumors comprised 82.6% of IO-USG-positive cases. At a median follow-up of 33.2 months, no axillary recurrences occurred.
[CONCLUSION] IO-USG may support personalized axillary management, helping avoid ALND in 76.4% of node-positive patients while identifying additional axillary metastases in 1.8% of SLNB-negative cases. As a complementary technique to standard SLNB, it appears to provide selective utility based on tumor biology.
[TRIAL REGISTRATION] Not applicable.
[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1186/s12957-026-04223-8.
[METHODS] This retrospective cohort study included 314 consecutive patients with invasive breast cancer who underwent SLNB with IO-USG evaluation between January 2019 and December 2023. IO-USG was performed after SLNB to identify suspicious non-sentinel nodes. Patients were categorized into SLNB-only, targeted axillary dissection (TAD), or ALND based on combined SLNB and IO-USG findings.
[RESULTS] Of 314 patients, 113 (36%) received neoadjuvant chemotherapy and 201 (64%) underwent upfront surgery. Final surgical management comprised SLNB-only in 244 (77.7%), TAD in 46 (14.7%), and ALND in 24 (7.6%) patients. Among 89 SLNB-positive patients, 68 (76.4%) avoided ALND through IO-USG guidance. IO-USG identified additional axillary metastases in 4 of 225 SLNB-negative patients (1.8%). Molecular subtype analysis revealed no IO-USG positivity in triple-negative cases (0/25), while HR+/HER2- tumors comprised 82.6% of IO-USG-positive cases. At a median follow-up of 33.2 months, no axillary recurrences occurred.
[CONCLUSION] IO-USG may support personalized axillary management, helping avoid ALND in 76.4% of node-positive patients while identifying additional axillary metastases in 1.8% of SLNB-negative cases. As a complementary technique to standard SLNB, it appears to provide selective utility based on tumor biology.
[TRIAL REGISTRATION] Not applicable.
[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1186/s12957-026-04223-8.