Can preoperative axillary ultrasound and biopsy of suspicious lymph nodes be an alternative to sentinel lymph node biopsy in clinical node negative early breast cancer?

Abstract

Aim:The aim of this study was to assess the efficacy of preoperative axillary ultrasonography (AUS) and preoperative axillary fine-needle aspiration biopsy (FNAB) from suspicious lymph nodes in clinically node-negative breast cancer to compare with radiologically positive and sentinel lymph node biopsy (SLNB) positive involvement.Method: Clinically node-negative early-stage breast cancer patients were included in the study. These patients underwent preoperative AUS examination, suspicious lymph nodes were evaluated with FNAB. AUS-FNAB results were compared with those of SLNB or axillary dissection.Results: Of 181 patients undergoing AUS, 32 were reported to have axillary metastasis, 25 suspicious, and 124 benign nodes. The suspicious group underwent FNAB examination and metastasis was found in 9 of them. The sensitivity of AUS-FNAB was found to be 64.06%, specificity 100%, positive predictive value 100%, and negative predictive value (NPV) 83.5%. The false negativity rate (FN) of this method was 16,4%. Lymphovascular invasion and tumour size were found statistically significant factors for false negativity. Conclusion:It was concluded that axillary AUS-FNAB with its high NPV, low FN rate, may be a clinical alternative to SLNB for early-stage breast cancer patients. How to cite this article: Özler İ, Aydin H, Güler OC, et al. Can preoperative axillary ultrasound and biopsy of suspicious lymph nodes be an alternative to sentinel lymph node biopsy in clinical node negative early breast cancer?. Int J Clin Pract.

Sonographic evaluation of axillary lymph node status in newly diagnosed breast cancer patients: A prospective study

“…[12][13][14] Furthermore, it is critical in guiding biopsies, such as fine-needle aspiration biopsy (FNAB) and/or core-needle biopsy (CNB), of suspicious lymph nodes to confirm the presence of metastases, which affects management plans. [15,16] Numerous studies have been conducted in adjacent countries and around the world to evaluate the accuracy and use of sonography in diagnosing lymph node metastases, with sensitivity and specificity ranging from 55% to 95%. [5,12,17] The search for noninvasive methods to determine ALN status continues, and the routine use of sonography in the preoperative examination of axillary LNs remains controversial.…”