Axillary lymph node fine needle aspiration in breast cancer staging: diagnostic impact of a second 20G spinal needle

Introduction

All breast cancer patients in our centre undergo ipsilateral axillary ultrasound, followed by fine needle aspiration (FNA) where appropriate in line with NICE guidelines. We use two needle passes into a suspicious node, without suction. Improved preoperative detection of nodal metastasis allows patients improved triage to appropriate axillary surgery. We present our analysis of the impact of the second needle in our axillary FNA procedure.

Methods

All breast cancer patients undergoing axillary FNA from April 2010 to July 2010 were included, where possible. The first FNA was labelled ‘1’ and the second ‘2’. Individual and overall FNA results were compared with final surgical pathology, where available.

Results

The study included 27 female patients. There was a difference in the cytology grading (described LN0 to LN5) allocated between the first and second needle in five cases (19%). The second needle increased sample adequacy on three (11%) occasions. Of the 17 patients that had axillary surgery, three had no lymph node metastases and the preoperative FNA cytology was LN2. There were no false positive cytology results. Preoperative cytology was LN5 overall in 11/14 (79%) patients with nodal metastases, with LN5 obtained only in the second pass in 4/14 (29%) cases (first-pass results: LN2/LN2/LN0/LN0). No complications were reported.

Conclusions

A second needle pass into suspicious axillary lymph nodes in breast cancer patients has been validated by this study, increasing our preoperative rate of detection of lymph node metastases.