DOI: http://dx.doi.org/10.18203/2349-2902.isj20185475

Effectiveness of ultrasound guided fine needle aspiration cytology of axillary node in women with clinically node negative breast cancer

T. Mohamed Rizwan, Moothedathparambil Ramakrishnan Babu, Krishnakumar Marar

Abstract


Background: The preoperative ultrasound (USG) guided fine needle aspiration cytology (FNAC) of axillary metastasis may avoid unnecessary axillary dissections and time consuming and costly sentinel lymph node biopsy. This study was aimed to evaluate the accuracy of USG guided FNAC in preoperative assessment of clinically node negative breast cancer patients.

Methods: An observational study was done in patients who fall within the inclusion criteria. USG guided FNAC of suspicious nodes was done. All the selected patients were taken up for modified radical mastectomy. The resected specimens were sent for detailed histopathological (HPR) evaluation, which was taken as the gold standard for the comparison with the pre-operative FNAC report.

Results: Among a total of 33 patients with early breast cancer subjected to USG guided FNAC and compared with the HPR results. The sensitivity, specificity, positive predictive value and negative predictive value of FNAC were 44.44%, 100%, 100% and 28.57% respectively.

Conclusions: The sensitivity of USG guided FNAC of suspicious axillary lymph nodes was low, whereas the specificity and positive predictive values were high. Moreover, the negative predictive value is very less. Hence, the results suggested that USG guided FNAC has not proved to be sufficiently accurate for routine preoperative assessment in patients with early breast cancer.


Keywords


Axillary metastasis, Breast cancer, FNAC, Radical mastectomy, Sentinel lymph node

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References


Annual ICMR. Indian Council of Medical Research; 2004-2005. Available at: www.icmr.nic.in.

Cox CE, Salud CJ, Cantor A, Bass SS, Peltz ES, Ebert MD, et al. Learning curves for breast cancer sentinel lymph Node mapping based on surgical volume analysis. J Am Coll Surg. 2001;193:593-600

de Kanter AY, van Eijck CH, van Geel AN, Kruijt RH, Henzen SC, Paul MA, et al. Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg. 1999;86:1459-62.

Krishnamurthy S, Sneige N, Bedi DG, Edieken BS, Fornage BD, Kuerer HM, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. 2002;95:982-8.

Kuenen-Boumeester V, Menke-Pluymers M, de Kanter AY, Obdeijn IM, Urich D, Van Der Kwast TH. Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients: a preoperative staging procedure. Eur J Cancer 2003;39:170-4.

Deurloo EE, Tanis PJ, Gilhuijs KG, Muller SH, Kröger R, Peterse JL, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultra-sonography of the axilla in breast cancer. Eur J Cancer. 2003;39:1068-73.

van Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 2006;13:31-5.

Sapino A, Cassoni P, Zanon E, Fraire F, Croce S, Coluccia C, et al. Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer. 2003;88:702-6.

Koelliker SL, Chung MA, Mainiero MB, Steinhoff MM, Cady B. Axillary lymph nodes: US guided fine-needle aspiration for initial staging of breast cancer-correlation with primary tumor size. Radiol. 2008;246:81-9.

Oruwari JU, Chung MA, Koelliker S, Steinhoff MM, Cady B. Axillary staging using ultrasound-guided fine needle aspiration biopsy in locally advanced breast cancer. Am J Surg. 2002;184:307-9

Ciatto S, Brancato B, Risso G, Ambrogetti D, Bulgaresi P, Maddau C, et al. Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging. Breast Cancer Res Treat. 2007 May 1;103(1):85-91.

Alkuwari E, Auger M. Accuracy of fine needle aspiration cytology of axillary lymph node in breast cancer patients: a study of 115 cases with cytologic-histologic correlation. Cancer. 2008;114:89-93.

Leenders MW, Broeders M, Croese C, Richir MC, Go HL, Langenhorst BL, et al. Ultrasound and fine needle aspiration cytology of axillary lymph nodes in breast cancer. To do or not do? Breast. 2012;21:578-83.

Pessoa EC, Rodrigues JR, Pessoa CP, Véspoli HM, Uemura G. Axillary lymph node aspiration guided by ultrasound is effective as a method of predicting lymph node involvement in patients with breast cancer. Rev Bras Ginecol Obstet. 2014;36:118-23.

Park SH, Kim MJ, Park BW, Moon HJ, Kwak JY, Kim EK, et al. Impact of preoperative ultrasonography and fine needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol. 2011;18:738-44.

Park SH, Kim EK, Park BW, Kim SI, Moon HJ, Kim MJ. False negative results in axillary lymph nodes by ultrasonography and ultrasonography guided fine needle aspiration in patients with invasive ductal carcinoma. Ultraschall Med. 2013;34:559-67.

Krishnamurthy S, Sneige N, Edieken BS, Fornage BD, Kuerer HM, et al. Role of ultrasound guided FNAC of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer.2002;95:982-8.

Oz A, Demirkazik FB, Akpinar MG, Soygur I, Baykal A, Onder SC, et al. Efficiency of ultrasound and ultrasound guided FNAC in preoperative assessment of axillary lymph node metastases in breast cancer. Breast Cancer. 2012;15:211-7.

Rocha RD, Andre Ricardo, Pinto RR, Rolim de Freitas VA. Axillary ultrasound and fine needle aspiration cytology in preoperative staging of axillary lymph nodes in patients with invasive breast cancer. Radiol Bras. 2015;48:345-52.