Emma Rooney Presents at 2018 Southeastern Surgical Congress

February 2018

PGY-1 Emory general surgery resident Emma Rooney, MD, presented "Are Lymph Node Characteristics on Axillary Ultrasound Associated with ≥3 Positive Lymph Nodes in Patients Managed by ACOSOG Z0011 Criteria?" at the 2018 Southeastern Surgical Congress meeting, held February 23-26 in Tampa, FL. Her presentation was selected as part of the Gold Medal plenary competition, and she placed third overall.

Dr. Rooney and her Department of Surgery faculty co-authors Theresa Gillespie, PhD, Cletus Arciero, MD, and senior author Preeti Subhedar, MD, examined whether ultrasound characteristics of axillary lymph nodes could be associated with the need to perform an axillary dissection.  

Breast cancer patients often receive axillary ultrasound-biopsy (AUS-B) prior to clinical evaluation. One positive biopsy in the absence of palpable disease rarely indicates additional nodal involvement, but it eliminates patients from being managed by Z0011 criteria.

To determine which patients may benefit from AUS-B, the team analyzed whether characteristics on AUS were associated with large volume axillary disease, and consequently the need for axillary lymph node dissection.

Multivariate analysis found that the combination of cortical thickness >4mm with the addition of any other abnormal lymph node characteristics (loss of fatty hilum or round shape) was associated with ≥3 positive LNs and thus likely to need a complete axillary lymph node dissection.

The co-investigators concluded that preoperative axillary LN biopsy in patients with a single abnormal LN may be unnecessary, particularly since a positive finding will eliminate management according to Z0011 criteria, but is rarely associated with a large burden of axillary disease.

Dr. Rooney also developed an algorithm for radiologists to use when deciding whether or not to preoperatively biopsy suspicious axillary lymph nodes. It is hoped that by using this algorithm, more patients will meet eligibility for management according to Z0011 criteria, thus reducing the morbidity of unnecessary procedures and therapies.

Dr. Rooney's work will be published in The American Surgeon in Spring 2018.

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