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

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.