Role of Axillary Ultrasound, Fine Needle Aspiration Cytology and Sentinel Lymph Node Biopsy in clinically N0 Breast Cancer

Abstract

This study evaluates the combined role of axillary ultrasound, fine needle aspiration cytology and sentinel lymph node biopsy in clinically N0 axilla. Between January 2014 and June 2015, 150 women with early breast cancer underwent axillary ultrasound as a first investigation for nodal status. Suspicious nodes were subjected to image guided fine needle aspiration cytology. Non-suspicious and fine needle aspiration cytology negative axillary nodes proceeded to sentinel lymph node biopsy at time of primary breast surgery. All confirmed positive (cytology and frozen) cases proceeded to axillary lymph node dissection. 52 women had positive axillary nodes at final histology. Axillary ultrasound with fine needle aspiration cytology identified 27 patients with positive axillary nodal status and had a sensitivity of 84.36 % (27/32) and specificity of 87.5 % (14/16). Intraoperative frozen analysis identified a further 13 cases with sensitivity of 56.52 % (13/23) and specificity of 97.56 % (80/82). Overall 76.92 % (40/52) patients with positive axillary metastasis were identified peri-operatively using combination of axillary ultrasound, cytology and sentinel lymph node biopsy.

Evaluation of the combined role of axillary ultrasound with fine-needle aspiration cytology and sentinel lymph node biopsy in detecting axillary metastasis in clinically N0 axilla at tertiary care center Kerala

“…Mastectomy was done in 77.1% cases and wide local excision in 22.9% cases. [14][15][16][17] Present study found that most common carcinoma observed on tumor histology was ductal carcinoma followed by lobular carcinoma. Another carcinoma like tubular, medullary, mucinous, papillary and mixed were also observed.…”

“…15 Goel et al observed 73.3% patients with invasive ductal carcinoma, 10% with invasive lobular carcinoma and 16.7% with other histologies (invasive tubular, medullary, mucinous, papillary, and mixed carcinoma) in their study. 16 Study done by Mainiero et al noted 191 invasive ductal carcinomas, 16 invasive lobular carcinomas, 13 with mixed invasive ductal and lobular carcinoma, and two invasive papillary carcinomas. 17 Present study noted most common tumor grade according to MBR system was grade II followed by grade I.…”

“…Goel et al observed that out of 150 patients, 40% had grade I, 45% had grade II, and 15% had grade III disease. 16…”

“…Ax US identified suspicious lymph node in almost in 1/3 rd cases and other were benign lymph node. Study done by Hu et al and Goel et al identified suspicious lymph node in almost in 65% and 34% cases and 35% and 66% were benign lymph node by Ax US respectively 15,16. PPV, NPV of Ax US with FNAC as 24.7%, 99.9%, 99.1% and 69.0% respectively.…”

“…Goel et al reported sensitivity, specificity, PPV, and NPV of Ax US alone were 65.4%, 82.5%, 66.7%, and 81.9% respectively and the sensitivity, specificity, PPV, and NPV of Ax US with FNAC were 84.5%, 87.5%, 93.1% and 73.7% respectively. Goel et al also reported sensitivity and specificity of FS SN was 56.5% and 97.6% respectively 16. Hu et al reported sensitivity, specificity, PPV, NPV and accuracy of Ax US was 59.2%, 78.3%, 60.0%, 77.7% and 71.5% respectively and of US guided FNAB was 71.1%, 100.0%, 100.0%, 69.8% and 82.7% respectively 15.…”