title: Role of ultrasound-guided fine needle cytology of axillary lymph nodes in breast carcinoma staging.
abstract: OBJECTIVE
  To evaluate the efficacy of cytology on axillary lymph node ultrasound-guided aspiration biopsy in the reduction of inappropriate surgery, such as the sentinel node (SN) procedure if positive, or axillary dissection if negative.
  
  
  METHODS
  Cytology was performed on 159 consecutive cases, on the ultrasonographically most suspicious lymph node. Lymph node histology was used as a reference standard to determine accuracy. Four different scenarios were simulated: routine axillary ultrasonography with cytology of the lymph nodes visible at ultrasonography (A), or of only the lymph nodes suspicious at ultrasonography (B), with ultrasonography limited to clinically negative axillae and cytology of the lymph nodes visible at ultrasonography (C), or only of the lymph nodes suspicious at ultrasonography only (D).
  
  
  RESULTS
  Cytologic sensitivity was 58.6%, specificity 100%. Immediate axillary dissection only in the case of positive cytology would have avoided 6/6 inappropriate axillary dissections and 5/34 (14.7%) inappropriate SN, compared to routine practice (immediate dissection for palpable adenopathy, SN in the remaining cases). Each of the simulated scenarios saved inappropriate surgical procedures (A: 6 dissections, 5 SNs; B: 6 dissections, 3 SNs; C: 13 SNs; D: 11 SNs) at no expense (A and B) or limited expense (C: Euro 348, D: Euro 232 for each inappropriate surgical procedure saved).
  
  
  CONCLUSIONS
  Axillary lymph node cytology can save axillary dissections or sentinel node procedures and is recommended as routine practice. Routine axillary ultrasonography, with cytology of sonographically visible lymph nodes, followed by immediate axillary dissection only in case of positive cytology proved to be the best approach in terms of cost-benefit ratio.
authors.affiliation: Centro per lo Studio e la Prevenzione Oncologica, Firenze, Italy.
authors.forename: Beniamino
authors.initials: B
authors.lastname: Brancato
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.forename: Daniela
authors.initials: D
authors.lastname: Bricolo
authors.forename: Sandra
authors.initials: S
authors.lastname: Catarzi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Risso
authors.forename: Rita
authors.initials: R
authors.lastname: Bonardi
authors.forename: Paola
authors.initials: P
authors.lastname: Cariaggi
authors.forename: Annalisa
authors.initials: A
authors.lastname: Bianchin
authors.forename: Paola
authors.initials: P
authors.lastname: Bricolo
authors.forename: Marco
authors.initials: M
authors.lastname: Rosselli Del Turco
authors.forename: Luigi
authors.initials: L
authors.lastname: Cataliotti
authors.forename: Simonetta
authors.initials: S
authors.lastname: Bianchi
authors.forename: Stefano
authors.initials: S
authors.lastname: Ciatto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000473:pathology*; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional