Efficiency of Ultrasound and Ultrasound-Guided Fine Needle Aspiration Cytology in Preoperative Assessment of Axillary Lymph Node Metastases in Breast Cancer

Abstract

PurposeWe performed this study to detect preoperative axillary metastases with ultrasound (US)-guided fine needle aspiration biopsy (FNAB), to eliminate the need for time-consuming and costly sentinel lymph node (SLN) scintigraphy and biopsy steps in the treatment of breast cancer patients, and in that of with suspicious US findings, and to evaluate the accuracy of preoperative US-guided FNAB for patients with suspicious lymph node metastases on US.MethodsPatients with a suspicious breast lump or histopathologically proven breast cancer underwent breast-axillary US. Increase in lymph node size, cortical thickening, non-hilar cortical flow, and hilar changes were evaluated with gray scale-color Doppler US. FNAB was performed if US results were suspicious for malignancy.ResultsThirty-eight axillary lymph nodes (ALN) underwent FNAB. ALN dissection, SLN scintigraphy, and biopsy steps were bypassed in 23 axillas with positive ALN FNAB (60.5%). The sensitivity of ALN FNAB was 88.46%; specificity and positive predictive value were 100%; and negative predictive value was 66.6% (inadequate cytology included; 76.7%, 100%, 100%, 53.3%, respectively). Asymmetrical cortical thickening, non-hilar cortical flow, and increase in hypoechogenity were only detected in metastatic nodes. Cortical thickening, and lymph node and breast mass size was higher in the metastatic group.ConclusionBy performing FNAB on suspicious lymph nodes, the routine, high-cost SLN scintigraphy and intraoperative gamma probe steps may be skipped, and axilla dissection can be performed directly. This leads to the elimination of the need for SLN investigation in more than half of the patients. The assessment of ALN metastases with preoperative US-guided FNAB is a cost-effective method with high specificity, that eliminates the need for costly and time-consuming SLN scintigraphy and biopsy steps, and helps in preoperative staging.

Correlation of Ultrasound Findings and Fine-Needle Aspiration Cytology for the Diagnosis of Axillary Lymph Node Metastasis in Patients with Breast Carcinoma

“…The majority (70–90%) underwent axillary dissection unnecessarily. This led to scalene lymph node biopsy becoming a commonly accepted method [17]. The common use of mammography screening has led to the early diagnosis of small-sized BCs.…”

Comparative study of diagnostic accuracy of mini-invasive pathological techniques with clinical and radiological examination in the diagnosis of suspicious breast masses

“…With the introduction of ultrasonographically (US)-guided methods for nonpalpable lesions, FNAC and CNB have been used more widely in the evaluation of nonpalpable breast lesions (Oz et al, 2012).…”

Comparative study between ultrasound-guided fine needle aspiration cytology of axillary lymph nodes and sentinel lymph node histopathology in early-stage breast cancer

“…However, thickness of the lymph node cortex is most highly associated with the presence of metastasis and may contribute to US-guided FNA (5). Oz et al (5) revealed that a cortical thickness >4.0 mm had a sensitivity of 86% and specificity of 87%, whereas at the cut-off point of 3.0 mm, specificity decreased to 37%. However, results in the literature are heterogenous, as ultrasonographic examination is operator-dependent and machine-dependent and there is a great variation in sensitivity and specificity when only US is used for evaluation of axillary lymph nodes (18)(19)(20).…”

“…(20)(21)(22)(23)(24)(25)(26)(27)(28). US-guided FNA has a high accuracy rate (5,7). Therefore, controversy concerning US-guided FNA cytology of axillary lymph nodes vs. SNB in early-stage breast cancer, in addition to the paucity of comparative studies between the two methods in Brazilian women, informed the current study design.…”

“…In Brazil, it has been estimated that 57,960 new cases and 14,207 deaths due to the disease will occur in 2016 (2,3). Breast cancer prognosis is directly associated with tumor staging at the time of diagnosis (4,5).…”