Abstract
BackgroundAxillary lymph node status is an important staging and prognostic factor in breast cancer. This study aimed to evaluate the efficacy of axilla fine needle aspiration cytology (FNAC) in primary breast cancer without a palpable node and even without image characteristics of a metastatic node.MethodsFrom June 2008 to January 2012, 77 patients met the inclusion criteria of having received a FNAC procedure during the diagnostic protocol of primary breast cancer with the characteristic of impalpable axilla nodes, and of having received axillary surgery after that, according to the guidelines. The patients’ characteristics, clinical-pathological features, pre-operative axillary lymph node FNAC findings, surgical lymph node report, and definite pathologic staging were reviewed.ResultsThe FNAC procedures had a reported sensitivity of 58.82%, specificity of 100%, positive predictive value of 100%, negative predictive value of 72.55%, and accuracy of 80.28%. There were no false positives on FNAC; therefore, the positive likelihood ratio approached infinity. The negative likelihood ratio was 41.18%. Axillary lymph node FNAC is feasible in newly diagnosed breast cancer patients to evaluate metastatic lymph nodes even in those without clinical or ultrasonic evidence of lymphadenopathy.ConclusionsFNAC can be a routine evaluation for most primary breast cancer patients with benefits in expediting treatment. For those patients with positive findings of the axilla, sentinel node biopsy can be avoided.
Highlights
Axillary lymph node status is an important staging and prognostic factor in breast cancer
Axillary lymph node status in the initial staging of newly diagnosed breast carcinoma is important for prognosis and assessment of treatment options
The aim of the study was to determine whether axillary lymph node ultrasound-guided fine needle aspiration cytology (FNAC) can be a safe, feasible, time-saving, sensitive, and specific tool to predict metastatic lymph nodes in primary breast cancer without palpable axillary lymph nodes or even imaging characteristics of a metastatic node
Summary
Axillary lymph node status is an important staging and prognostic factor in breast cancer. Fine needle aspiration cytology (FNAC) of suspicious nodes via clinical examination and/or ultrasound has become a popular practice in many breast units. It is performed without anesthesia and is generally well tolerated by the patient, with fewer complications than needle core biopsy. In most of the reported series, the focus has been on patients with a suspicious axillary node identified by ultrasonography or who had palpable lymph nodes and underwent FNAC. This selection may reduce the bias of the operator-dependent procedure, but limits the application with regards to primary breast cancer patients
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