In early-stage breast cancer, sentinel lymph node biopsy can save unnecessary axillary dissection compared with fine-needle aspiration cytology for indeterminate axillary lymph nodes

Abstract

Introduction The most prevalent female cancer is breast cancer. A significant prognostic factor and determinant of treatment is the state of axillary lymph nodes (LNs). Axillary LNs can be classified into pathological, indeterminate, and benign by ultrasonographic (US) assessment. Aim In early-stage breast cancer, the indeterminate axillary LNs are measured. This offers the full advantage of the available diagnostic instruments, fine-needle aspiration cytology (FNAC), and sentinel lymph node biopsy (SLNB) technique driven by US, and thus prevents excessive dissection of the axillary lymph node. In a step-wise sequence, suggestions are made for the treatment of indeterminate axillary LNs. Patients and methods This is a randomized, controlled sample that is prospective. Between October 2017 and October 2018, 60 female patients diagnosed with early-stage breast cancer with indeterminate axillary nodes were admitted to the breast cancer unit at Kasr Alainy University Hospital, Cairo University. Sensitivity, accuracy, positive predictive value, and negative predictive value of preoperative US-guided FNAC versus upfront frozen indeterminate node intraoperative SLNB were contrasted, and both findings were correlated to the final histo-guided FNAC. Results Sensitivity of SLNB was 83.33%, whereas sensitivity of the FNAC was 75%, with the negative predictive value of 83.33%, specificity of 83.3%, and positive predictive value of 75%. Conclusion FNAC is only moderately sensitive (75%), and inadequate sampling and being an operator dependent are potential limits of it. In addition, positive FNAC may cost the patient unnecessary axillary lymph node dissection.