Axillary Ultrasound and Fine-Needle Aspiration in the Preoperative Evaluation of the Breast Cancer Patient: An Algorithm Based on Tumor Size and Lymph Node Appearance

Abstract

Ultrasound-guided FNA of the axillary lymph nodes is most useful in the preoperative assessment of patients with large tumors (> 2 cm) or lymph nodes that appear abnormal.

The current role of radiologists in a multidisciplinary team treating breast cancer

“…Fine-needle aspiration has several advantages, as this method is less aggressive, better tolerated by the patients, less expensive, and has a sensitivity is similar to that of percutaneous core biopsy. Although fine-needle aspiration is less specific, a positive result for metastatic adenocarcinoma is sufficient to obviate sentinel lymph node biopsy (26).…”

“…It is essential to know the axillary status for staging, choosing the appropriate treatment and establishing the patient´s prognosis (26,27). Sentinel lymph node biopsy has replaced axillary lymphadenectomy as the method of choice for detecting lymph node metastases because this technique reduces the axillary morbidity (lymphedema, paresthesias) without a reduction in diagnostic accuracy in experienced institutions.…”

“…However, a degree of risk persists, and the method is highly dependent on the surgeon's experience and is time-and resource-consuming, so it is advisable to minimize the number of procedures (27, 28). Axillary US and axillary US-guided fine-needle aspiration or percutaneous core biopsy are rapid, inexpensive and safe methods of staging the disease of the axilla, and there is much evidence of usefulness (26)(27)(28). Axillary US should be performed to detect lymph nodes suspected of malignancy, which are characterized by a cortical thickening greater than 3 mm, a bulge in contour and the absence of a central fatty hilum (the most suspicious features), a rounded (not oval) shape and predominantly peripheral vascularization (26,27,29).…”

“…A positive result makes sentinel lymph node biopsy an unnecessary technique at this time, and axillary lymphadenectomy, with the dissection of axillary levels I and II (low and middle), should be performed during a surgical breast procedure. If a negative result is obtained or if suspicious lymph nodes are not observed by axillary US, a sentinel lymph node biopsy must be performed because it is a more sensitive method (3,4,26).…”

“…Axillary US and axillary fine-needle aspiration or percutaneous core biopsy offer a low yield in patients with tumors less than 1 cm in diameter, so it only seems advisable to perform axillary US in patients with tumors larger than 1 cm (26).…”