Role of ultrasound‐guided fine‐needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma

Abstract

BACKGROUNDUltrasound (US) is more sensitive than physical examination alone in determining axillary lymph node involvement during preliminary staging of breast carcinoma. Due to occasional overlap of sonographic features of benign and indeterminate lymph nodes, fine‐needle aspiration (FNA) of sonographically indeterminate/suspicious lymph nodes can provide a more definitive diagnosis than US alone. This study was undertaken to determine the diagnostic accuracy of US‐guided FNA of indeterminate/suspicious/metastatic‐appearing axillary lymph nodes during the initial staging of breast carcinoma.METHODSThe cytology of 103 cases of US‐guided FNA of nonpalpable indeterminate/suspicious/metastatic‐appearing lymph nodes was compared with the final histopathologic status of the entire axilla after axillary dissection. The final axillary lymph node status was categorized as either negative when all lymph nodes were negative for metastasis or positive when there was evidence of metastasis in one or more lymph nodes. The sensitivity, specificity, diagnostic accuracy, and false‐negative rate of US‐guided FNA of nonpalpable axillary lymph nodes in the preliminary staging process were calculated.RESULTSIn 51 of 103 cases (49.5%), the US‐guided FNA and histopathology were both positive for metastasis. In 24 of 103 cases (23.3%), both were negative. The apparent false‐positive FNA in 16 (15.5%) cases was explained by the complete response of the metastatic lymph nodes to neoadjuvant chemotherapy in the interval between FNA and axillary dissection. In 12 cases (11.6%), US‐guided FNA was negative, but metastasis was seen in histologic sections. All cases with three or more lymph nodes with metastatic disease and 93% of those with metastatic deposit measuring more than 0.5 mm were detected by US‐guided FNA. The probability of detecting lymph nodes with smaller metastatic deposit measuring less than 0.5 cm was 44%. The overall sensitivity of US‐guided FNA was 86.4%, the specificity was 100%, the diagnostic accuracy was 79.0%, the positive predictive value was 100%, and the negative predictive value was 67%.CONCLUSIONSUS‐guided FNA of nonpalpable indeterminate and suspicious axillary lymph nodes is a simple, minimally invasive, and reliable technique for the initial determination of axillary lymph node status in breast carcinoma. The common causes of discrepancy between the initial and final axillary lymph node status include failure to visualize all lymph nodes during US examination, small‐sized metastases, and preoperative neoadjuvant chemotherapy. Cancer 2002;95:982–8. © 2002 American Cancer Society.DOI 10.1002/cncr.10786

Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients

“…These results compare favorably with those in the literature, in which the sensitivity of ultrasound-guided FNAs for lymph nodes ranges from 36% to 86.4%, the specificity ranges from 95.7% to 100%, the PPV ranges from 92% to 100%, and the NPV ranges from 67% 8 to 70%. [7][8][9]11,15 The data from the current study demonstrated that the sensitivity of lymph node FNA was lower in the sentinel lymph node group than in the full lymph node dissection group (ie, 16% vs 88%, respectively). All the false-negative FNAs, with the exception of 1, were because of sampling error.…”

“…9 To improve the accuracy of the preoperative assessment of axillary lymph nodes, others have used FNA and found it to be simple, moderately accurate, and minimally invasive, and a good triage tool for the management of patients. 1,[7][8][9][10][11][12][13]15,19 Indeed, it has been shown that combining axillary ultrasonography with FNA cytology of abnormal lymph nodes can significantly reduce the number of unnecessary sentinel lymph node procedures performed by 8% to 40%, with a concomitant reduction in healthcare costs of up to 20%. [7][8][9][10]15,19 The data from the current study confirm that FNA cytology is a useful procedure with which to detect axillary lymph node metastases from breast carcinoma.…”

“…Different methods are used to detect metastases in axillary lymph nodes preoperatively. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Although some studies have used ultrasonographic imaging techniques alone, [2][3][4][5][6]12,17,18 others have used fine-needle aspiration (FNA) cytology with or without ultrasound guidance to improve the detection of metastases. 1,[7][8][9][10][11][12][13]15,19 FNA cytology of axillary lymph nodes is a simple, minimally invasive technique that can be utilized as a tool with which to select patients for sentinel versus full lymph node dissection procedures in We thank Dr. R. P. Michel for editorial assistance with the article.…”

Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer

“…In order to increase the specificity of preoperative assessment of the axilla, a number of groups have performed US-guided FNA (Bonnema et al, 1997;Verbanck et al, 1997;De Kanter et al, 1999;Krishnamurthy et al, 2002). Bonnema and de Kanter used this technique to detect axillary metastases in patients with operable breast cancer and preoperatively identified 63% (39 of 62) and 36% (31 of 87) of node-positive patients, respectively.…”

Incidentally detected lesions on contrast‐enhanced MR imaging in candidates for breast‐conserving therapy: Correlation between MR findings and histological diagnosis

“…Incidentally detected lesions on contrast-enhanced MR images were reported to have been found in 16% to 29% of the patients on breast MRs performed for various reasons (10,11), and the presence of these lesions should affect surgical planning in patients with breast cancer, especially in patients with those in a different quadrant from the main lesion. Ultrasonography (US)-guided aspiration cytology has been proven to be useful, but the sample obtained might be insufficient for histopathological diagnosis (12)(13)(14).…”