Ultrasound‐Guided Aspiration Biopsy for Detection of Nonpalpable Axillary Node Metastases in Breast Cancer Patients: New Diagnostic Method

Abstract

This study was designed to evaluate the accuracy of ultrasonography alone and in combination with fine-needle aspiration biopsy (FNAB) for detection of axillary metastases of nonpalpable lymph nodes in breast cancer patients. Ultrasonography was carried out in 150 axillas of 148 patients (mean age 57 years, range 30-80 years); and in 93 axillas lymph nodes were detected. Nodes were described according to their dimension and echo patterns and were compared with histopathologic results. FNAB was carried out in 81 axillas (122 nodes). The sensitivity of ultrasonography was highest (87%) when size (length >5 mm) was used as criterion for malignancy, but the specificity was rather low (56%). When nodes with a malignant pattern (echo-poor or inhomogeneous) were visualized, specificity was 95%. Ultrasound-guided FNAB had a sensitivity of 80% and a specificity of 100% and detected metastases in 63% of node-positive patients. It is concluded that FNAB is an easy, reliable, inexpensive method for identifying patients with positive nodes. In the case of negative findings, other diagnostic procedures to exclude lymph node metastases, such as sentinel node mapping, could be performed.

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

“…We here reported a 16% false negative rate by US alone, since 28 out of 172 of US-nonsuspect LN were positive at histology. However, a great improvement of the diagnostic accuracy emerged when US examination was combined with FNAC of LN suspect to be metastatic, as demonstrated by the few available reports on the subject (Bonnema et al, 1997;Verbanck et al, 1997;de Kanter et al, 1999de Kanter et al, , 2000. In fact, in our study and in previous ones that used a similar approach, the cytological diagnosis of metastases reached 100% specificity.…”

“…In fact, in our study and in previous ones that used a similar approach, the cytological diagnosis of metastases reached 100% specificity. On the other hand, Bonnema et al (1997) reported 80% sensitivity and a 76% negative predictive value of the cytological method. In the present work, we observed an increase in both sensitivity (89%) and negative predictive value (84%), which has to be related to the additional use of ICC.…”

“…There are very few reports of image-guided LN fine-needle aspiration cytology (FNAC) as a means of improving presurgical staging of the axilla in breast cancer patients (Bonnema et al, 1997;Verbanck et al, 1997;de Kanter et al, 1999).…”

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.…”

“…The range of sensitivity and specificity quoted in the literature for these techniques is such that the clinical management of the axilla cannot be modified for individual patients based upon these test results. US-guided fine needle aspiration (FNA) has been able to identify 36 -63% of node-positive patients preoperatively (Bonnema et al, 1997;De Kanter et al, 1999). Image-guided core biopsy has a higher sensitivity than FNA for assessing breast lesions (Britton and McCann, 1999), and therefore it would be anticipated that a similar improvement in sensitivity would be observed in USguided core biopsy of the axilla.…”