Preoperative ultrasound‐guided fine‐needle aspiration cytology for axillary staging in breast carcinoma

Abstract

Axillary lymph node (ALN) status is considered to be the single most important prognostic indicator in patients with breast cancer. It can be assessed by various radiological, pathological and surgical techniques, the most accurate being histological examination of lymph nodes after axillary lymph node dissection (ALND). This prospective study was conducted to assess the feasibility and diagnostic accuracy of preoperative ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (USG-FNAC) of ALN in patients with breast cancer. Thirty patients with FNAC-proven breast cancer, planned for definitive surgery with axillary clearance, were included in this study. Ultrasonographic evaluation of the axillae of these patients was conducted for alterations in size, shape, contour and cortical morphology of lymph nodes that could reflect presence of underlying metastases. Ultrasound-guided fine-needle aspiration cytology of the ALN was done in 24 of these patients. These findings were evaluated, with the ALN status determined by histological examination after ALND. Out of the 30 patients, eight had T(1), 16 had T(2), five had T(3), and one had T(4) lesions. Ultrasound evaluation of the ALN had a sensitivity of 86.3%, a specificity of 41.6%, a positive predictive value of 79%, a negative predictive value of 50% and a diagnostic accuracy of 73.3%. Sensitivity of USG-FNAC was 78.95%, specificity was 100%, positive predictive value was 100%, negative predictive value was 55.56% and diagnostic accuracy was 83.33%. Our study concludes that preoperative USG-FNAC of ALN is a simple, minimally invasive, easily available and reliable technique for the initial determination of ALN status in patients with breast cancer. Those who are USG-FNAC positive can be directed towards ALND straight away, and only those who are USG-FNAC negative should be considered for sentinel lymph node biopsy. This will save considerable operating time, especially where facilities for sentinel lymph node biopsy (costly dye, gamma camera, nuclear medicine facilities) are restricted or not available.

Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients

“…The difference in the sensitivity of the FNA in the sentinel lymph node group compared with the full lymph node dissection group relates to the small size of the metastatic foci in the sentinel lymph node group, decreasing the likelihood of sampling the metastatic foci. Other studies have also shown that the most common cause of false-negative cases is inadequate sampling, 11 either because of the small size of the metastases, 1,3,7 the low number of lymph nodes positive for metastasis, 1,3,19 or failure to observe the lymph nodes during examination of the axilla by ultrasound. 1,3,18,19 Reported causes of false-positive diagnoses in the literature are due mostly to cytologic misinterpretation of cells 11 or inadequate sampling of the lymph node dissection.…”

“…Other studies have also shown that the most common cause of false-negative cases is inadequate sampling, 11 either because of the small size of the metastases, 1,3,7 the low number of lymph nodes positive for metastasis, 1,3,19 or failure to observe the lymph nodes during examination of the axilla by ultrasound. 1,3,18,19 Reported causes of false-positive diagnoses in the literature are due mostly to cytologic misinterpretation of cells 11 or inadequate sampling of the lymph node dissection. 19 In the current study, there were no false-positive FNA cases; indeed, although 1 FNA specimen diagnosed as metastatic breast carcinoma was not confirmed histologically (all of the 28 lymph nodes resected were found to be negative), review of the FNA smears and cell block material demonstrated unequivocally malignant cells.…”

“…9 To improve the accuracy of the preoperative assessment of axillary lymph nodes, others have used FNA and found it to be simple, moderately accurate, and minimally invasive, and a good triage tool for the management of patients. 1,[7][8][9][10][11][12][13]15,19 Indeed, it has been shown that combining axillary ultrasonography with FNA cytology of abnormal lymph nodes can significantly reduce the number of unnecessary sentinel lymph node procedures performed by 8% to 40%, with a concomitant reduction in healthcare costs of up to 20%. [7][8][9][10]15,19 The data from the current study confirm that FNA cytology is a useful procedure with which to detect axillary lymph node metastases from breast carcinoma.…”

“…Different methods are used to detect metastases in axillary lymph nodes preoperatively. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Although some studies have used ultrasonographic imaging techniques alone, [2][3][4][5][6]12,17,18 others have used fine-needle aspiration (FNA) cytology with or without ultrasound guidance to improve the detection of metastases. 1,[7][8][9][10][11][12][13]15,19 FNA cytology of axillary lymph nodes is a simple, minimally invasive technique that can be utilized as a tool with which to select patients for sentinel versus full lymph node dissection procedures in We thank Dr. R. P. Michel for editorial assistance with the article.…”

Diagnostic Accuracy of Ultrasonograph Guided Fine-needle Aspiration Cytologic in Staging of Axillary Lymph Node Metastasis in Breast Cancer Patients: a Meta-analysis

“…Consequently, 44 articles included information relating FNAC and breast cancer diagnosis. But only 21 of 44 articles satisfied the requirements of the meta-analysis fully (Bonnema et al, 1997;Bedrosian et al, 2003;Deurloo et al, 2003;Kuenen-Boumeester et al, 2003;Sapino et al, 2003;Duchesne et al, 2005;Podkrajsek et al, 2005;Popli et al, 2006;van Rijk et al, 2006;Altomare et al, 2007;Ciatto et al, 2007;Alkuwari et al, 2008;Tahir et al, 2008;Baruah et al, 2010;Jung et al, 2010;Luparia et al, 2010;Carroll et al, 2011;Devaraj et al, 2011;Hayes et al, 2011;Schiettecatte et al, 2011), addressing the value of FNAC in staging of axillary lymph node in breast cancer patients. The detailed procedure was seen in Figure 1.…”