Is ultrasound-guided fine-needle aspiration cytology of adequate value in detecting breast cancer patients with three or more positive axillary lymph nodes?

Abstract

This study evaluated the accuracy of ultrasound-guided fine-needle aspiration cytology of the sonographically most suspicious axillary lymph node (US/FNAC) to select early breast cancer patients with three or more tumour-positive axillary lymph nodes. Between 2004 and 2014, a total of 2130 patients with histologically proven early breast cancer were evaluated and treated in the Noordwest Clinics Alkmaar. US/FNAC was performed preoperatively in all these patients. We analysed the results of US/FNAC retrospectively. Pathological axillary node status (sentinel node biopsy and/or axillary lymph node dissection) was used as reference standard. A total of 634 (29.8 %) of 2130 patients had axillary lymph node metastases on final histology. 248 node positive patients (11.6 %) had three or more positive lymph nodes. The accuracy of US/FNAC to detect three or more positive lymph nodes was 89.8 %, sensitivity was 44.8 %, specificity was 95.7 %, PPV was 58.1 %, and NPV was 92.9 %. This study shows a more than adequate accuracy of preoperative US/FNAC to detect three or more positive lymph nodes (89.8 %). However, when US/FNAC was chosen as the only axillary staging method, 6.4 % of all patients (false negative group) would have been undertreated and 3.8 % of all patients (false positive group) would have been overtreated according to the ACOSOG Z0011 criteria.

The role of preoperative axillary ultrasound and fine-needle aspiration cytology in identifying patients with extensive axillary lymph node involvement

“…The metaanalysis by van Wely et al [29] shows that 56% of the patients with positive A-FNAC have three or more positive ALNs, and the other big study by G.M. Kramer et al [30] shows almost identical numbers, with a positive predictive value (PPV) of 58%. These patients could probably benefit from additional axillary treatment.…”

Sentinel lymph node nonvisualization after intratumoral radioisotope tracer injection in breast cancer is not associated with a higher nodal metastasis rate or worse outcomes

“…The routine use of preoperative ultrasonography of the axilla in combination with fine‐needle aspiration cytology (US/FNAC) of regional lymph nodes was not reported in the studies that found extensive nodal metastatic involvement in patients with nonvisualization on preoperative imaging . Kramer et al demonstrated that preoperative US/FNAC has an adequate accuracy of 89.8% to detect three or more positive lymph nodes. After US/FNAC, most of the patients with extensive nodal metastatic involvement would not undergo a SLNB procedure.…”

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

“…USG-FNAC is widely utilized to investigate enlarged or abnormal lymph nodes in BC patients [19, 20]. The technique has been shown to have good diagnostic accuracy, with a sensitivity of 65–99% and a specificity of 80–100% [21]; to detect ≥3 positive nodes, sensitivity was 44.8%, specificity 95.7%, PPV 58.1%, and NPV 92.9% [20].…”

“…The technique has been shown to have good diagnostic accuracy, with a sensitivity of 65–99% and a specificity of 80–100% [21]; to detect ≥3 positive nodes, sensitivity was 44.8%, specificity 95.7%, PPV 58.1%, and NPV 92.9% [20]. Rapid on-site evaluation of ALNs in aspirated specimens has been shown to be diagnostically helpful [21, 22].…”