Accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology for axillary staging in breast cancer

Background: The aims of this study were to evaluate the accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration (FNA) cytology (US-FNAC) for detecting axillary metastases, and to assess how often sentinel node biopsy could be avoided. Methods: Axillary ultrasound, as a part of routine preoperative staging, was performed in 189 patients with histologically proven breast cancer. US-FNAC was performed on all lymph nodes (LNs) with features suggestive of metastatic disease on ultrasound characteristics and LNs larger than 1 cm regardless of whether the nodes appear normal or abnormal. The cytologic results were compared with the final histological diagnosis. Results: The sensitivity, specificity and positive and negative predictive values of the ultrasound alone of axillary LNs for metastatic breast cancer were 54, 91, 75 and 81%, retrospectively. For the US-FNAC, the respective values were 80, 98, 97 and 84%. Conclusions: Preoperative axillary ultrasound in combination with US-FNAC provides a simple, minimally invasive and reliable approach to the initial determination of the axillary LN status. Those who are US-FNAC positive can be referred for axillary LN dissection without sentinel LN biopsy.