Rationale and Objectives. To compare the sensitivities of ultrasound guided core biopsy and fine needle aspiration (FNA) for detection of axillary lymph node metastases in patients with a current diagnosis of ipsilateral breast cancer. Materials and Methods. From December 2008 to December 2010, 105 patients with breast cancer and abnormal appearing lymph nodes in the ipsilateral axilla consented to undergo FNA of an axillary node immediately followed by core biopsy of the same node, both with ultrasound guidance. Experienced pathologists evaluated the aspirate cytology without knowledge of the core histology. Cytology and core biopsy results were compared to sentinel node excision or axillary dissection pathology. Sensitivities were compared using McNemar’s test. Results. Of 70 patients with axillary node metastases, FNA was positive in 55/70 (78.6%) and core was positive in 61/70 (87.1%) ( ). The FNA and core results were discordant in 14/70 (20%) patients. Ten cases were FNA negative/core positive. Four cases were FNA positive/core negative. Conclusion. Core biopsy detected six (8.6%) more cases of metastatic lymphadenopathy than FNA but the difference in sensitivities was not statistically significant. Core biopsy should be considered if the node is clearly imaged and readily accessible. FNA is a good alternative when a smaller needle is desired due to node location or other patient factors. This trial is registered with NCT01920139. 1. Introduction The prognosis of the newly diagnosed breast cancer patient depends on a number of factors, among the most important of which is the extent of spread of disease to the axillary lymph nodes [1, 2]. Because treatment is influenced by the presence and number of axillary lymph nodes involved, evaluation of the axillary nodes has been performed in every patient that could tolerate it after a diagnosis of invasive carcinoma [3]. In the past, a complete surgical dissection of the axilla was performed, resulting in significant morbidity, including a 30% incidence of lymphedema [4]. The development of sentinel node mapping resulted in a notable reduction in morbidity; however, if a sentinel node was positive, often not discovered until final pathologic processing done postoperatively, complete axillary dissection would be performed at a later date to assess the total number of lymph nodes involved, thus requiring a second surgical procedure and anesthesia [5–7]. A preoperative diagnosis of axillary metastasis by ultrasound guided node biopsy would streamline patient care and reduce operating room time and expense
References
[1]
B. Fisher, M. Bauer, D. L. Wickerham, et al., “Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update,” Cancer, vol. 52, no. 9, pp. 1551–1557, 1983.
[2]
S. Masood, “Prognostic factors in breast cancer,” The Breast Journal, vol. 3, no. 5, pp. 267–283, 1997.
[3]
Z. U. Rahman, A. U. Buzdar, E. Singletary, et al., “Selection of systemic therapy: is axillary lymph node status important?” Seminars in Breast Disease, vol. 1, no. 3, pp. 137–166, 1998.
[4]
D. Brenin and M. Morrow, “Conventional axillary dissection: extent, local control, and morbidity,” Seminars in Breast Disease, vol. 1, no. 3, pp. 118–124, 1998.
[5]
J. J. Albertini, G. H. Lyman, C. Cox et al., “Lymphatic mapping and sentinel node biopsy in the patient with breast cancer,” Journal of the American Medical Association, vol. 276, no. 22, pp. 1818–1822, 1996.
[6]
N. M. Hansen, “Historical review of sentinel node biopsy for breast cancer,” Seminars in Breast Disease, vol. 5, no. 1, pp. 2–9, 2002.
[7]
B. J. Grube and A. E. Giuliano, “Implications of sentinel lymphadenectomy and management options of the axilla after sentinel node biopsy: sentinel node negative and sentinel node positive,” Seminars in Breast Disease, vol. 5, no. 2, pp. 61–75, 2002.
[8]
A. E. Giuliano, L. McCall, P. Beitsch et al., “Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American college of surgeons oncology group z0011 randomized trial,” Annals of Surgery, vol. 252, no. 3, pp. 426–432, 2010.
[9]
R. Welsh, P. J. Kornguth, M. S. Soo, R. Bentley, and D. M. DeLong, “Axillary lymph nodes: mammographic, pathologic, and clinical correlation,” American Journal of Roentgenology, vol. 168, no. 1, pp. 33–38, 1997.
[10]
P. Vassallo, K. Wernecke, N. Roos, and P. E. Peters, “Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US,” Radiology, vol. 183, no. 1, pp. 215–220, 1992.
[11]
E. E. Deurloo, P. J. Tanis, K. G. A. Gilhuijs et al., “Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer,” European Journal of Cancer, vol. 39, no. 8, pp. 1068–1073, 2003.
[12]
V. Kuenen-Boumeester, M. Menke-Pluymers, A. Y. de Kanter, I.-M. A. Obdeijn, D. Urich, and T. H. van der Kwast, “Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure,” European Journal of Cancer, vol. 39, no. 2, pp. 170–174, 2003.
[13]
S. Sahoo, M. A. Sanders, L. Roland, N. Pile, and A. B. Chagpar, “A strategic approach to the evaluation of axillary lymph nodes in breast cancer patients: analysis of 168 patients at a single institution,” American Journal of Surgery, vol. 194, no. 4, pp. 524–526, 2007.
[14]
S. Krishnamurthy, N. Sneige, D. G. Bedi et al., “Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma,” Cancer, vol. 95, no. 5, pp. 982–988, 2002.
[15]
J. U. N. Oruwari, M. A. Chung, S. Koelliker, M. M. Steinhoff, and B. Cady, “Axillary staging using ultrasound-guided fine needle aspiration biopsy in locally advanced breast cancer,” American Journal of Surgery, vol. 184, no. 4, pp. 307–309, 2002.
[16]
A. Sapino, P. Cassoni, E. Zanon et al., “Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management,” British Journal of Cancer, vol. 88, no. 5, pp. 702–706, 2003.
[17]
B. Brancato, M. Zappa, D. Bricolo et al., “Role of ultrasound-guided fine needle cytology of axillary lymph nodes in breast carcinoma staging,” Radiologia Medica, vol. 108, no. 4, pp. 345–355, 2004.
[18]
S. L. Koelliker, M. A. Chung, M. B. Mainiero, M. M. Steinhoff, and B. Cady, “Axillary lymph nodes: US guided fine-needle aspiration for initial staging of breast cancer—Correlation with primary tumor size,” Radiology, vol. 246, no. 1, pp. 81–89, 2008.
[19]
W. A. Berg, “Image-guided breast biopsy and management of high-risk lesions,” Radiologic Clinics of North America, vol. 42, no. 5, pp. 935–946, 2004.
[20]
U. Topal, ？. Punar, I. Ta？delen, and S. B. Adim, “Role of ultrasound-guided core needle biopsy of axillary lymph nodes in the initial staging of breast carcinoma,” European Journal of Radiology, vol. 56, no. 3, pp. 382–385, 2005.
[21]
H. Abe, R. A. Schmidt, C. A. Sennett, A. Shimauchi, and G. M. Newstead, “US-guided core needle biopsy of axillary lymph nodes in patients with breast cancer: why and how to do it,” Radiographics, vol. 27, pp. S91–S99, 2007.
[22]
N. Houssami, S. Ciatto, R. M. Turner, H. S. Cody, and P. MacAskill, “Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla,” Annals of Surgery, vol. 254, no. 2, pp. 243–251, 2011.
[23]
R. Rao, L. Lilley, V. Andrews, L. Radford, and M. Ulissey, “Axillary staging by percutaneous biopsy: sensitivity of fine-needle aspiration versus core needle biopsy,” Annals of Surgical Oncology, vol. 16, no. 5, pp. 1170–1175, 2009.
[24]
S. Rautianen, A. Masarwah, M. Sudah, et al., “Axillary iymph node biopsy in newly diagnosed breast cancer: comparative accuracy of fine-needle aspiration biopsy versus core needle biopsy,” Radiology, vol. 269, pp. 54–60, 2013.
