Ultrasound and fine needle aspiration cytology of axillary lymph nodes in breast cancer
The Breast, 06/22/2012
Leenders MWH et al. – =Node–positive axillae were identified by ultrasound–guided fine needle aspiration cytology (FNAC) and spared unnecessary sentinel node biopsy. Unfortunately, the percentage of false negative results of ultrasound–guided FNAC was very high.Methods
- Between 2004 and 2009, 1132 female patients were evaluated and treated in the clinic for histologically proven breast carcinoma.
- Preoperative axillary ultrasound with subsequent FNAC in case of suspicious lymph nodes was performed in 1150 axillae (18 bilateral breast carcinomas).
- The authors analyzed the results of axillary ultrasound and FNAC retrospectively.
- Pathological node status was used as the reference standard (based on axillary dissection or sentinel node biopsy).
- Axillary ultrasound showed suspicious lymph nodes in 327 axillae (28.4%).
- FNAC showed axillary metastases in 107 of these 327 axillae.
- Final histological analysis confirmed 106 metastases (one false positive).
- Histological analysis showed metastatic disease in 429 of 1150 axillae (37.3%).
- Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of axillary ultrasound alone were 43.8% (188/429), 80.7% (582/721), 57.5% (188/327) and 70.7% (582/823), respectively.
- When combining axillary ultrasound with FNAC of suspicious lymph nodes, sensitivity was 24.7% (106/429), specificity was 99.9% (720/721), PPV was 99.1% (106/107) and NPV was 69.0% (720/1043).