Axillary lymph node ultrasound (U/S) and fine needle aspiration (FNA) biopsy: What are their values in breast cancer management planning?.

Abstract

Purpose: To evaluate the combined-value of Axillary Lymph Node (ALN) ultrasonography and FNA in anticipating ALN metastasis (ALNM) in breast cancer patients at breast screen level with the aim of avoiding unnecessary Sentinel Lymph Node Biopsy (SLNB) before Axillary Lymph Node Dissection (ALND). Methods and materials: 174 patients with histopathologically-proven breast carcinoma for whom breast surgery with SLNB or ALND was recommended, were enrolled into the study from January 2008 to Jun 2009, prospectively. Preoperative U/S assessments of the primary tumour and axilla were performed. Sonographic features like visualization of lymph nodes, short and long axis sizes, shape, cortical thickness, echogenicity, hilum change, contour irregularity, surrounding abnormalities and Doppler of peripheral vessels were evaluated. If abnormal ALN were identified, most of these were evaluated with FNA. Results: Thirty eight patients (21.83%) had ALNM. Abnormal U/S findings were observed in 40 individuals from whom just fifteen (8.6%) were true positives for ALNM. While, the overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value of ALN U/S in anticipating ALNM were 39.5%, 81.6%, 37.5% and 82.8%, respectively, ALN FNA showed specificity and PPV of 100% with diagnostic rate of 89.6%. Marked hypo-or anechogenicity was by far the strongest predictor of ALNM (odd ratio: 10.11, P = 0.002). Tumour size >15 millimetres (mm) was the second strongest variable in our study (odd ratio: 4.37, P < 0.001). Of 56 patients with breast tumour size >15 mm and ALN visualized on U/S, 24 (42.85%) individuals had ALNM (P < 0.001). Conclusion: Ultrasound-guided-FNA of suspicious ALN is a highly accurate and specific test which can bypass the unnecessary SLNB before ALND.<br />