Volume 17 Supplement 1
Sensitivity of US and FNAC for staging of the axilla in patients presenting with symptomatic breast cancer
© Lister et al. 2015
Published: 5 November 2015
We investigated our sensitivity for axillary node staging, in patients presenting with symptomatic breast cancer from January to December 2012.
Of 430 patients identified, 288 had first-line surgical treatment, 63 had neoadjuvant therapy first. Seventy-nine women were unfit for surgery, had less aggressive evaluation of the axilla and were excluded from sensitivity calculations. US axilla ± FNA were performed at presentation. Nodal disease prevalence, sensitivity for diagnosis and the NPV of our tests were calculated. In the neoadjuvant cases, pretreatment nodal status was not accurately known.
The prevalence of nodal metastases in our surgery first cases was 43% (123/288). Twenty-four per cent of cases were micrometastases (29/123). US sensitivity for macrometastases was 51% (48/94); 41% including micrometastases (50/123). FNA sensitivity for macrometastases was 38% (36/94; 35 results C5); 30% (37/123) including micrometastases. Combining all groups, FNA was definitive (C5 or C2) in 90% (134/149) of cases. The NPV of imaging was 65% (137/210); 75% (137/183) with micrometastases excluded. The NPV of a C1/2 result was 72% (28/39) giving a false negative FNA rate of 28%. Of neoadjuvant cases, FNA was positive in 60% (38/63; 35 results C5), giving a minimum disease prevalence and diagnostic sensitivity of 60%. Combining both groups, nodal disease prevalence lies between 46% (161/351) and 53% (186/351). FNA sensitivity is between 48 and 57% for macrometastases (75/157; 75/132); and 40−46% including micrometastases (75/186; 75/161).
Axillary staging depends on both US sensitivity and FNAC technique. US sensitivity is adversely affected by micrometastases. In our symptomatic patients, FNA sensitivity for macrometastases lies between 48 and 57%.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.