Predictive value of fine needle aspiratıon biopsy of axillary lymph nodes in preoperative breast cancer staging
Muzaffer Akıncı1, Serap Pamak Bulut1, Fazilet Erözgen1, Mihriban Gürbüzel2, Gökçe Gülşen3, Ahmet Kocakuşak1, Mehmet Gülen1, Rafet Kaplan1
1Clinic of General Surgery, Haseki Training and Research Hospital, İstanbul, Turkey
2Clinic of Pathology, Haseki Training and Research Hospital, İstanbul, Turkey
3Clinic of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey
Objective: Diagnosis of axillary nodal involvement is significant in the management of breast cancer as well as in predicting prognosis. In this prospective study, we evaluated the efficiency of US-guided fine needle aspiration biopsy (FNAB) in preoperative axillary staging of early breast cancer.
Material and Methods: Between January 2011 and July 2013, 46 women were prospectively enrolled in the study. Ultrasound guided-FNABs for axillary assessment were performed preoperatively. Cytology results were compared with histopathology reports to determine its sensitivity, specificity, negative and positive predictive value and accuracy.
Results: Nineteen cases that had malignant cytology on FNAB also had axillary involvement in axillary lymph node dissection (ALND) without any false-positive results. The sensitivity and specificity of US-guided FNAB were 63.3% and 100%, respectively. US-guided FNAB was accurate in predicting the status of the axilla in 76.1% of patients.
Conclusion: Although this technique is favorable due to its minimally invasive nature, it is not as effective as sentinel lymph node biopsy (SLNB) in terms of detecting axillary metastasis preoperatively. The low sensitivity and low accuracy rates decrease the usefulness of the technique. Therefore, it seems that US-guided FNAB alone could not replace SLNB. Nevertheless, combining some other molecular studies may be useful in increasing the technique’s sensitivity. These issues should be determined by comprehensive clinical trials.
Keywords: Breast cancer, axillary ultrasound, axillary staging, axillary lymph node sampling, axillary fine-needle aspiration biopsy
Written informed consent was obtained from patients who participated in this study.
Concept - F.E., S.P.B.; Design - S.P.B.; Supervision - M.A., R.K.; Resources - M.A., F.E.; Materials - S.P.B.; Data Collection and/or Processing - S.P.B., M.Gür., G.G.; Analysis and/or Interpretation - S.P.B., M.A.; Literature Search - S.P.B.; Writing Manuscript - S.P.B.; Critical Review - A.K., M.G., M.A.; Other - G.G., M.Gür.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.