Evaluation of Ultrasound-Guided Fine Needle Aspiration of Axillary Nodes in Breast Cancer Patients With Indicated Sentinel Node Biopsy

Abstract

The status of axillary lymph nodes is an important prognostic factor of breast cancer with impact on the choice of treatment and survival of patients. In the absence of distant metastasis axillary status represents one of the most important prognostic factors in assessing the patient with breast cancer. The evolution of surgical treatment of breast cancer, including in relation to axillary approach, contributed to the reduction of morbidity of treatment. The technique of sentinel lymph node biopsy (SLNB) became increasingly common practice replacing the complete axillary lymphadenectomy (AL) in evaluation of axillary lymph nodes. The preoperative diagnosis of axillary metastases may prevent the realization of the SLNB and the patient goes directly to the AL. This is a cross-sectional and prospective study aiming to analyze the use of ultrasound guided fine needle aspiration (FNA) for axillary lymph nodes and to determine the usefulness of this method in the preoperative staging of breast cancer patients candidates for SLNB. Ultrasound guided FNA were performed in 40 patients who had axillary lymph nodes with ultrasonography alterations suspected of malignancy, in a total of 41axillaes studied. Patients with malignant cytology avoided SLNB and were submitted directly to AL, patients with negative cytology held SLNB. The histological findings were compared with the results of ultrasound guided FNA. In evaluating FNA cytology, 18 (43.90%) patients presented cytology compatible with malignancy and 23 (56.10%) were benign. Comparing with the findings of the axillaries surgeries the axillary ultrasound guided FNA demonstrated a sensitivity of 81.8%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 82.6% and 90,2% of accuracy. The data demonstrate that the technique is an effective procedure in preoperative assessment in patients with breast cancer, selecting the treatment and saving costs and time.