Scientific Presentation Award: The combination of axillary ultrasound and ultrasound-guided biopsy is an accurate predictor of axillary stage in clinically node-negative breast cancer patients

Abstract

Background: The study aim was to determine the accuracy of axillary ultrasound (AUS) and fine-needle aspiration biopsy (FNAB)/needle core biopsy in axillary breast cancer staging.

Methods: We reviewed 256 patients with clinically node-negative breast cancer who underwent AUS +/- FNAB/needle core biopsy. AUS-guided FNAB/needle core biopsy was compared with histopathology to determine sensitivity, specificity, negative predictive value, and positive predictive value.

Results: AUS-guided FNAB/needle core biopsy and final pathology were positive in 72 of 256 patients (28%). In 125 of 256 cases (49%), the AUS and final pathology were negative. Two of 110 patients had a false-positive FNAB (1.8%); both received neoadjuvant chemotherapy. Nine patients (8%) had a false-negative FNAB/needle core biopsy; the median size of lymph node metastasis was 3 mm. The sensitivity and specificity of AUS-guided FNAB/needle core biopsy was 71% and 99%, respectively, with a negative predictive value of 84% and a positive predictive value of 97%.

Conclusions: AUS-guided FNAB/needle core biopsy is accurate in predicting the status of the axilla in 70% of clinically node-negative breast cancer patients. This technique is minimally invasive with a low complication rate and can obviate the need for staged lymph node procedures.

Figures

Figure 1

Axillary ultrasound characteristics of normal and abnormal lymph nodes. Normal lymph nodes have a smooth, homogenous cortex with a centrally located, preserved fatty hilum (1A). Abnormal, or suspicious for metastatic involvement, lymph nodes have a rounded appearance with an eccentrically thickened, heterogenous cortex and effacement of the fatty hilum (1B).

Figure 1

Axillary ultrasound characteristics of normal and abnormal lymph nodes. Normal lymph nodes have a smooth, homogenous cortex with a centrally located, preserved fatty hilum (1A). Abnormal, or suspicious for metastatic involvement, lymph nodes have a rounded appearance with an eccentrically thickened, heterogenous cortex and effacement of the fatty hilum (1B).

Figure 2

Flow chart representing the axillary ultrasound (AUS), fine needle aspiration biopsy/needle core biopsy (shown as FNAB on diagram for simplicity), and final lymph node pathology for patients with clinically negative axillary lymph nodes.