Ultrasound and fine needle aspiration assessment of the axilla in patients with operable invasive breast cancer

Introduction

Axillary lymph node dissection has been standard practice for staging invasive breast cancer. As sentinel lymph node biopsy is being performed as an alternative less invasive procedure, identification of positive axillary nodes by ultrasound (US) needle biopsy is important in identifying involved axillae and thereby excluding patients from inappropriate sentinel node procedures.

Method

We evaluated the axilla of 71 patients with invasive breast cancer and sampled abnormal nodes by the fine needle aspiration (FNA) technique. Criteria for biopsy were cortex > 2 mm, eccentrically thickened cortex and loss of normal morphology. The results were correlated with final histopathologic status after surgery.

Results

Twenty-two out of 71 patients demonstrated abnormal nodes on US, 12 of these 22 were malignant at surgery. In total, 18/71 patients had involved nodes at time of surgery; 9/18 were identified by the US/FNA technique. Sensitivity, specificity, positive and negative predictive values were 50%, 100%, 100% and 71%, respectively.

Conclusion

US-guided FNA is a convenient method for identifying involved axillary nodes. Axillary US alone would result in a significant proportion of false-positive diagnoses.