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Preoperative Axillary Ultrasound and Fine-needle Aspiration Biopsy in the Diagnosis of Axillary Metastases in Patients with Breast Cancer: Predictors of Accuracy and Future Implications

Annals of Surgical Oncology volume 20, pages 819–827 (2013)Cite this article

Abstract

Background

The utility of axillary lymph node dissection after sentinel lymph node biopsy has been called into question. We sought to determine the sensitivity, specificity, and accuracy of axillary ultrasound and fine-needle aspiration biopsy (FNAB) in the identification of axillary nodal metastasis in early breast cancer patients.

Methods

Data of patients with stage I and II breast cancer who underwent surgery and staging were reviewed. Axillary ultrasound findings were assessed and lymph node status recorded after axillary dissection. The data were cross-tabulated, and test characteristics were calculated.

Results

Of 235 patients, none demonstrated more than 2 positive sentinel lymph nodes. Ductal carcinoma was present in 68 %, estrogen and progesterone receptors were positive in 81 and 64 %, respectively, Her-2/neu was positive in 10 %, and 36 % were axillary node positive. The sensitivity and specificity of ultrasound alone were 55 and 88 %, respectively. Predictors of abnormal ultrasound included size of metastasis, estrogen receptor and Her-2 status, tumor grade, and presence of lymphovascular invasion. Addition of FNAB increased the sensitivity and specificity to 69 and 100 %. In conjunction with FNAB, the positive and negative predictive values were 100 and 54 %, respectively. Ten percent of patients with nodal metastases demonstrated a positive FNAB. Patients with a positive FNAB did not harbor more nodal metastases or a greater proportion of gross extranodal disease compared to patients not subjected to FNAB.

Conclusions

Axillary ultrasound with FNAB has an accuracy of >70% in this series. It is easily performed and may avoid unnecessary sentinel lymph node biopsy in a significant number of patients.

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Authors and Affiliations

  1. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

    Jonathan Cools-Lartigue MD, Nora Trabulsi MD, Ari Meguerditchian MD & Sarkis Meterissian MD

  2. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada

    Alison Sinclair MD, PhD & Rebecca Fuhrer PhD

  3. Department of Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada

    Benoit Mesurolle MD

Authors
  1. Jonathan Cools-Lartigue MD
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  2. Alison Sinclair MD, PhD
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  4. Ari Meguerditchian MD
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  5. Benoit Mesurolle MD
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  7. Sarkis Meterissian MD
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Correspondence to Jonathan Cools-Lartigue MD.

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Cools-Lartigue, J., Sinclair, A., Trabulsi, N. et al. Preoperative Axillary Ultrasound and Fine-needle Aspiration Biopsy in the Diagnosis of Axillary Metastases in Patients with Breast Cancer: Predictors of Accuracy and Future Implications. Ann Surg Oncol 20, 819–827 (2013). https://doi.org/10.1245/s10434-012-2609-7

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  • DOI: https://doi.org/10.1245/s10434-012-2609-7

Keywords

  • Sentinel Lymph Node Biopsy
  • Positive Sentinel Lymph Node Biopsy
  • Axillary Ultrasound
  • Axillary Disease
  • Sentinel Lymph Node Biopsy Group