Accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology for axillary staging in breast cancer.

BACKGROUND

The aims of this study were to evaluate the accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration (FNA) cytology (US-FNAC) for detecting axillary metastases, and to assess how often sentinel node biopsy could be avoided.

METHODS

Axillary ultrasound, as a part of routine preoperative staging, was performed in 189 patients with histologically proven breast cancer. US-FNAC was performed on all lymph nodes (LNs) with features suggestive of metastatic disease on ultrasound characteristics and LNs larger than 1 cm regardless of whether the nodes appear normal or abnormal. The cytologic results were compared with the final histological diagnosis.

RESULTS

The sensitivity, specificity and positive and negative predictive values of the ultrasound alone of axillary LNs for metastatic breast cancer were 54, 91, 75 and 81%, retrospectively. For the US-FNAC, the respective values were 80, 98, 97 and 84%.

CONCLUSIONS

Preoperative axillary ultrasound in combination with US-FNAC provides a simple, minimally invasive and reliable approach to the initial determination of the axillary LN status. Those who are US-FNAC positive can be referred for axillary LN dissection without sentinel LN biopsy.