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

Abstract

Objective: Ultrasound-guided fine-needle aspiration cytology (USG-FNAC) is used for the detection of axillary lymph node (ALN) metastasis in patients with breast carcinoma (BC). US findings have a good diagnostic accuracy with high sensitivity and specificity. The aim of this study is to correlate the detection of ALN metastases on US with FNAC in BC patients. Study Design: In 75 BC patients, over a period of 9 months (January to September 2017), the size, cortical thickness (CT), presence or absence of hilar fat, and length/width ratio of ALN on US were reviewed and correlated with FNAC findings. Results: The age range was 29–78 (mean 52) years. There were 38 patients with a single ALN and 37 with multiple ALNs. ALNs with a maximum length of > 2.5 cm were malignant in 100% of cases while those ≥1.5 cm were malignant in 80.4%. ALNs with a CT of > 3 mm had metastasis in 78.1% cases. ALNs with absent hilar fat showed tumour in 87.5% cases. A length/width ratio of < 2 showed a metastatic tumour in 66.7% of aspirates. Conclusion: An association was seen between metastatic carcinoma on FNAC and axillary US features of a maximum length of ≥1.5 cm, the absence of hilar fat, and a CT of > 3 mm (p < 0.05).

Clinical Value of Three Combined Ultrasonography Modalities in Predicting the Risk of Metastasis to Axillary Lymph Nodes in Breast Invasive Ductal Carcinoma

“…Among all malignant tumors in women, breast cancer has the highest incidence ( 14 ). Early breast cancer has no obvious symptoms, causes serious physical and mental harm to women, and poses a serious threat to their lives.…”

Role of Ultrasound in Pretreatment Evaluation of Lymph Node Status in Carcinoma Breast: A Systematic Review

“…Four studies used cortical thickness of 3 mm as cutoff for LN metastasis, out of these three used histopathology as gold standard and one used cytology as gold standard. 12,13,16,17 These were published in years 2009, 2012, 2015, and 2018, and studied a total of 643 patients. The sensitivity in these studies ranged from 66.7 to 96.6% and specificity from 12.5 to 74.5%.…”

“…Five studies used histopathology as a gold standard whereas PPV of 80.4%, and NPV of 50%. 13 Choudhary et al in 2018 used cutoff of 0.7 cm or more for diagnostic accuracy of size and found highest sensitivity of 94.8% with a specificity of 52.2%. 14…”

A roadmap for a comprehensive diagnostic approach to fine needle cytology of lymph node metastases

“…Moreover, FNC can also identify some specific morphological features, indicative of certain types of tumour differentiation, such as adenocarcinomas and sarcomas, as well as a pool of possible primary origins. Although the cytological features of metastases from almost any type of malignant tumour have been described, most of the published data generally focus on FNC of metastatic lymph nodes from single specific neoplasms or from single topographic locations 8–17 . Unfortunately, the reality in routine clinical practice is much more complex than that.…”

“…Although the cytological features of metastases from almost any type of malignant tumour have been described, most of the published data generally focus on FNC of metastatic lymph nodes from single specific neoplasms or from single topographic locations. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 Unfortunately, the reality in routine clinical practice is much more complex than that. Indeed, lymphadenopathies of various anatomical districts still pose a great diagnostic challenge for cytopathologists.…”