Abstract
BackgroundAxillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years. This study evaluated if axillary ultrasound (US) coupled with fine-needle aspiration cytology (FNAC) can accurately predict clinically relevant node metastasis in patients with breast cancer, and thus assist clinical decisionsMethodsThis is a cross-sectional study with retrospective data collection of 241 individuals (239 women and 2 men) with unilateral operable breast cancer who were submitted to preoperative axillary assessment by physical exam, US and FNAC if suspicious nodes by imaging. We calculated sensitivity, specificity, and accuracy of the methods. We compared the patient's characteristics using chi-square test, parametrics and non-parametrics statistics according to the variable.ResultsThe most sensible method was US (0.59; 95% CI, 0.50–0.69), and the most specific was US coupled with FNAC (0.97; 95% CI, 0.92–0.99). Only 2.7% of the patients with normal axillary US had more than 2 metastatic nodes in the axillary lymph node dissection, against 50% of the patients with suspicious lymph nodes in the US and positive FNAC.ConclusionsAxillary US coupled with FNAC can sort patients who have a few metastatic nodes at most from those with heavy axillary burden and could be one more tool to initially evaluate patients and define treatment strategies.
Highlights
Axillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years
The aim of our study was to evaluate if axillary US coupled with fine-needle aspiration cytology (FNAC) of the suspicious nodes can better predict lymph node metastasis than physical exam in patients with breast cancer
Physical exam and axillary ultrasound are able to predict accurately a low axillary lymph node involvement, but the false-negative rate of the methods does not obviate the need for sentinel node biopsy (SLNB) [11, 25]
Summary
Axillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years. The role of axillary dissection in sentinel node-positive, early breast cancer patients has been questioned by several trials, including Z0011. They found that ALND did not confer an advantage compared to SLNB in survival nor recurrence, in a subset of T1–2 patients with no palpable adenopathy and 1 or 2 metastatic lymph nodes [5]. Following this trend, non-invasive, less invasive, and costly methods to access the axilla have been studied. It is important to highlight that these methods are expensive and not broadly available
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