Axillary ultrasound and fine-needle aspiration cytology to predict clinically relevant nodal burden in breast cancer patients

Abstract

Background Axillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years. This study evaluated if axillary ultrasound (US) coupled with fine-needle aspiration cytology (FNAC) can accurately predict clinically relevant node metastasis in patients with breast cancer, and thus assist clinical decisions Methods This is a cross-sectional study with retrospective data collection of 241 individuals (239 women and 2 men) with unilateral operable breast cancer who were submitted to preoperative axillary assessment by physical exam, US and FNAC if suspicious nodes by imaging. We calculated sensitivity, specificity, and accuracy of the methods. We compared the patient's characteristics using chi-square test, parametrics and non-parametrics statistics according to the variable. Results The most sensible method was US (0.59; 95% CI, 0.50–0.69), and the most specific was US coupled with FNAC (0.97; 95% CI, 0.92–0.99). Only 2.7% of the patients with normal axillary US had more than 2 metastatic nodes in the axillary lymph node dissection, against 50% of the patients with suspicious lymph nodes in the US and positive FNAC. Conclusions Axillary US coupled with FNAC can sort patients who have a few metastatic nodes at most from those with heavy axillary burden and could be one more tool to initially evaluate patients and define treatment strategies.

Development and validation of a pre- and intra-operative scoring system that distinguishes between non-advanced and advanced axillary lymph node metastasis in breast cancer with positive sentinel lymph nodes: a retrospective study

“…ILC was an independent risk factor for advanced ALNM in our study. US findings of axillary nodes coupled with FNA have been reported to be useful in predicting heavy axillary burden [ 25 ]. Advanced ALNM with false-negative US findings was more prevalent in patients with ILC than in those with infiltrating ductal carcinoma (IDC) because of the morphological features of ILC [ 26 , 27 ].…”

The Current Status of Ultrasonography and Fine-Needle Aspiration Citology for the Management of the Axilla in Breast Cancer

“…19 Del Riego et al evaluated the efficacy of ultrasound axillary and preoperative FNAC, to detect patients with breast cancer and more than two metastatic nodes, in 288 patients who met the selection criterio of ACOSOG Z0011. 20 The results were as follows: sensitivity 83%, specificity 80.6%, positive predictive value 45.4%, negative predictive value 96.1%. Buzzato et al in 2021 published a study that evaluated if axillary ultrasound coupled with FNAC can accurately predict clinically relevant node metastasis in patients with breast cancer, and thus assist clinical decisions.…”

Case report: Lymph node metastasis of pelvic alveolar rhabdomyosarcoma diagnosed by fine needle aspiration cytology

“…Combined with various assistive techniques, the correctness of the FNAC diagnosis is comparable to that of histopathological biopsy for some kinds of tumors ( 6 , 9 ). FNAC of suspicious lymph nodes also provides additional information on tumor staging, which can better guide subsequent treatment ( 10 , 11 ).…”