Skip to main content

Advertisement

SpringerLink
Log in

Comparison of Ultrasound-Guided Fine Needle Aspiration Cytology and Ultrasound-Guided Core Biopsy in Preoperative Axillary Staging for Early Breast Cancer

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Current national guidance supports the use of either ultrasound-guided core biopsy (USCB) or ultrasound-guided fine needle aspiration cytology (USFNAC) to detect preoperatively axillary lymph node involvement in early breast cancer but does not support one over the other. To compare the accuracy of USFNAC to USCB in diagnosing axillary lymph node metastasis in early-stage breast cancer in our symptomatic breast care unit. Historical case series data for patients from November 2007 to May 2012 was analysed. Our study included newly diagnosed, symptomatic, clinically node-negative breast cancers. Women with screen-detected breast cancer, those who had breast staging by magnetic resonance imaging, those unfit for surgery and those with locally advanced cancers were excluded. GE Logic E9 and Philips ultrasound machines were used for the study. A total of 1213 axillary ultrasound scans were performed during the period of the study. Four hundred eighty-eight women were eligible for the study with a mean age of 57.8 years. Eighty-three (17%) had USFNAC, 116 (23.7%) had USCB and 289 (59.2%) had normal/benign US features. The sensitivity and specificity of USFNAC were 58% and 100%, respectively. For USCB, sensitivity and specificity were 82% and 100%, respectively, and for US alone, sensitivity and specificity were 50% and 77%, respectively. We support the routine use of USCB over USFNAC for women who have breast cancer with indeterminate or suspicious axillary involvement on ultrasound, due to its greater accuracy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Chart 1

Similar content being viewed by others

References

  1. Vidya R, Iqbal FM, Bickley B (2017) Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology? Ecancermedicalscience. 11:724

    Article  Google Scholar 

  2. Willett AM, Michell MJ, Lee MJR, Eds. (2010) Best Practice diagnostic guidelines for patients presenting with breast cancer symptoms. UK Cancer Reform Strategy Breast Cancer Working Group, Department of Health

  3. Borrelli C, Cohen S, Duncan A, Given-Wilson R, Jenkins J, Kearins O, Pinder S, Sharma N, Sibbering M, Steel J, Turnbull A, Wallis MG. Clinical guidance for breast cancer screening assessment. NHS Breast Screening Programme, Public Health England. Publication no. 49, 4th edition Nov 2016

  4. Kim GR, Choi JS, Han BK, Lee JE, Nam SJ, Ko EY, Ko ES, Lee SK (2018) Preoperative axillary US in early-stage breast cancer: potential to prevent unnecessary axillary lymph node dissection. Radiology. 288(1):55–63

    Article  Google Scholar 

  5. Cornford E, James J (2010) Radiological assessment of the axilla in breast cancer. Cambridge University Press, 169–190

  6. Mainiero MB, Cinelli CM, Koelliker SL, Graves TA, Chung MA (2010) Axillary ultrasound and fine-needle aspiration in the preoperative evaluation of the breast cancer patient: an algorithm based on tumour size and lymph node appearance. AJR 195:1261–1267

    Article  Google Scholar 

  7. Gardner MJ, Altman DG (1989) Calculating confidence intervals for proportions and their differences. In: Gardner MJ, Altman DG (eds) Statistics with confidence. BMJ Publishing Group, London, pp 28–33

    Google Scholar 

  8. Maguire A, Brogi E (2016) Sentinel lymph nodes for breast carcinoma: an update on current practice. Histopathology. 68(1):152–167

    Article  Google Scholar 

  9. Damera A, Evans AJ, Comford EJ, Wilson ARM, Burrell HC, James JJS, Pinder E, Ellis IO, Lee AHS, Macmillan RD (2003) Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operative breast cancer. Br J Cancer 89(7):1310–1313

    Article  CAS  Google Scholar 

  10. Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M, Costa A, de Cicco C, Geraghty JG, Luini A, Sacchini V, Veronesi P (1997) Sentinal lymph node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 349(9069):1864–1867

    Article  CAS  Google Scholar 

  11. Goyal A, Newcombe RG, Chhabra A, Mansel RE (2008) Morbidity in breast cancer patients with sentinel node metastases undergoing delayed axillary lymph node dissection [ALND] compared with immediate ALND. Ann Surg Oncol 15(1):262–267

    Article  Google Scholar 

  12. Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in earlystage breast carcinoma: a metanalysis. Cancer 106(1):4–16

    Article  Google Scholar 

  13. Friale M, Rull M, Julian FJ, Fusté F, Barnadas A, Llatjós M, Castellà E, Gonzalez JR, Vallejos V, Alastrué A, Broggi MA (2000) Sentinel lymph node biopsy as a practical alternative to axillary lymph node dissection in breast cancer patients: an approach to its validity. Ann Oncol 11(6):701–705

    Article  Google Scholar 

  14. Britton PD, Provenzano E, Barter S, Gaskarth M, Goud A, Moyle P, Sinnatamby R, Wallis M, Benson JR, Forouhi P, Wishart GC (2009) Ultrasound guided percutaneous axillary lymph node core biopsy: how often is the sentinel lymph node being biopsied? Breast. 18(1):13–16

    Article  CAS  Google Scholar 

  15. Cho N, Moon WK, Han W, Park IA, Cho J (2009) NohD. Preoperative sonographic classification of axillary lymph nodes in patients with breast cancer: node-to-node correlation with surgical histology and sentinal lymph node biopsy results. AJR Am J Roentgenol 193(6):1731–1737

    Article  Google Scholar 

  16. Britton P, Moyle P, Benson JR, Goud A, Sinnatamby R, Barter S, Gaskarth M, Provenzano E, Wallis M (2010) Ultrasound of the axilla: where to look for the sentinel lymph node. ClinRadiol. 65(5):373–376

    CAS  Google Scholar 

  17. Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ, Kröger R, Kroon BB (2006) Ultrasonography and fine- needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol 13(1):31–35

    Article  Google Scholar 

  18. Hayes BD, Feeley L, Quinn CM, Kennedy MM, O’Doherty A, Flanagan F, O’Connell AM (2011) Axillary fine needle aspiration cytology for pre-operative staging of patients with screen detected invasive breast carcinoma. J ClinPathol 64(4):338–342

    Google Scholar 

  19. Kuenen-Boumeester V, Menke-Pluymers M, de Kanter AY, Obdeijn IM, Urich D, Van Der Kwast TH (2003) Ultrasound guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure. Eur J Cancer 39(2):170–174

    Article  CAS  Google Scholar 

  20. Swinson C, Ravichandran D, Nayagam M, Allen S (2009) Ultrasound and fine needle cytology of the axilla in the pre-operative identification of axillary nodal involvement in breast cancer. Eur J Surg Oncol 35(11):1152–1157

    Article  CAS  Google Scholar 

  21. Bonnema J, van Geel AN, Mali SP, Tjiam SL, Henzen-Logmans SC, Schmitz PL, Woggers T (1997) Ultrasound-guided aspiration biopsy for detection of non-palpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg World J Surg 21(3):270–274

    Article  CAS  Google Scholar 

  22. Duchesne N, Jaffey J, Florack P, Duchesne S (2005) Redefining ultra- sound appearance criteria of positive axillary lymph nodes. CanAssocRadiol J 56(5):289–296

    Google Scholar 

  23. Rao R, Lilley L, Andrews V, Radford L, Ulissey M (2009) Axillary staging by percutaneous biopsy: sensitivity of fine-needle aspiration versus core needle biopsy. Ann Surg Oncol 16(5):1170–1175

    Article  Google Scholar 

  24. Ciatto S, Brancato B, Risso G, Ambrogett D, Bulgaresi P, Maddau C (2007) Accuracy of fine needle aspiration cytology [FNAC] of axillary lymph nodes as a triage test in breast cancer staging. Breast Cancer Res Treat 103(1):85–91

    Article  Google Scholar 

  25. Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM (2009) Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US- guided 14-gauge core-needle biopsy-clinical experience in 100 patients. Radiology. 250(1):41–49

    Article  Google Scholar 

  26. Abe H, Schmidt RA, Sennett CA, Shimauchi A, Newstead GM (2007) US-guided core needle biopsy of axillary lymph nodes in patients with breast cancer: why and how to do it. Radiographics 27(Suppl1):S91–S99

    Article  Google Scholar 

  27. Solon JG, Power C, Al-Azawi D, Duke D, Hill ADK (2012) Ultrasound-guided core biopsy: an effective method of detecting axillary nodal metastases. J Am Coll Surg 214(1):12–17

    Article  Google Scholar 

  28. Britton PD, Goud A, Godward S, Barter S, Freeman A, Gaskarth M, Rajan P, Sinnatamby R, Slattery J, Provenzano E, O’Donovan M, Pinder S, Benson JR, Forouhi P, Wishart GC (2009) Use of ultrasound-guided axillary node core in staging of early breast cancer. EurRadiol 19(3):561–569

    CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Mrs. S Hart, RNA, DipHE and Breast Care Nurse, Radiology Department, St Albans City Hospital, for collection of data and helping in data analysis.

Author information

Authors and Affiliations

  1. Department of Surgery, West Hertfordshire Breast Care Unit, St Albans City Hospital, Waverley Road, St. Albans, Hertfordshire, AL3 5PN, UK

    J. Maalo, S. Monib, L. M. Lai & S. Thomson

  2. Department of Radiology, West Hertfordshire Breast Care Unit, St Albans City Hospital, St Albans, Hertfordshire, UK

    Amit Suri & E. Pakdemirli

Authors
  1. J. Maalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Monib
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amit Suri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Pakdemirli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. M. Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Thomson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SM, JM, LML, ST, AS and EP were responsible for ongoing patients’ care. SM, JM, AS, EP and ST were involved in data collection and analysis. SM, JM, AS, EP and ST researched and drafted the manuscript.

Corresponding author

Correspondence to S. Monib.

Ethics declarations

Competing Interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maalo, J., Monib, S., Suri, A. et al. Comparison of Ultrasound-Guided Fine Needle Aspiration Cytology and Ultrasound-Guided Core Biopsy in Preoperative Axillary Staging for Early Breast Cancer. Indian J Surg 83 (Suppl 2), 345–351 (2021). https://doi.org/10.1007/s12262-019-02023-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-019-02023-x

Keywords

Search

Navigation