title: Axillary lymph node echo-guided fine-needle aspiration cytology enables breast cancer patients to avoid a sentinel lymph node biopsy. Preliminary experience and a review of the literature.
abstract: OBJECTIVE
  For many years, the status of the axillary lymph nodes has been determined by an axillary lymphadenectomy. However, a sentinel lymph node biopsy has been shown to effectively replace the need for an axillary lymphadenectomy in order to determine the axillary staging. This study presents the preliminary results regarding the efficacy of fine-needle aspiration cytology (FNAC) to identify metastatic axillary lymph nodes in the pre-operative phase.
  
  
  METHODS
  One hundred lymph nodes from 100 patients with histologically and cytologically confirmed breast cancer (cT1-2 cN0) underwent echo-guided FNAC. The diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) for the axillary metastases was evaluated based on the histological findings of either a sentinel lymph node biopsy or an axillary lymphadenectomy as a reference standard.
  
  
  RESULTS
  It was possible to avoid a sentinel lymph node biopsy in 30% of the cases; the sensitivity was 68%, specificity 100%, PPV 100%, and NPV 65%. Echo-guided FNAC of the axillary lymph nodes should thus be included among the regular diagnostic procedures of presurgical staging.
  
  
  CONCLUSIONS
  This simple, inexpensive, and minimally invasive technique makes it possible to avoid the additional cost of a sentinel lymph node biopsy while also sparing the patient the stress of undergoing a second surgery.
authors: Breast Unit, Campus Bio-Medico University, Rome, Italy.
authors: Vittorio
authors: V
authors: Altomare
authors: Gabriella
authors: G
authors: Guerriero
authors: Rita
authors: R
authors: Carino
authors: Cleonice
authors: C
authors: Battista
authors: Angelo
authors: A
authors: Primavera
authors: Annamaria
authors: A
authors: Altomare
authors: Donata
authors: D
authors: Vaccaro
authors: Alessandro
authors: A
authors: Esposito
authors: Anna Maria
authors: AM
authors: Ferri
authors: Carla
authors: C
authors: Rabitti
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology*; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
references: Eur J Cancer. 2003 May;39(8):1068-73
references: 12736105
references: Am J Surg. 2004 Jun;187(6):679-83
references: 15191856
references: Radiology. 1992 Apr;183(1):215-20
references: 1549675
references: Radiol Med. 2004 Oct;108(4):345-55
references: 15525888
references: Eur J Cancer. 2003 Jan;39(2):170-4
references: 12509948
references: Radiology. 1986 Feb;158(2):325-6
references: 3510440
references: Br J Surg. 1999 Nov;86(11):1459-62
references: 10583296
references: Eur Radiol. 2000;10(9):1464-71
references: 10997438
references: Tumori. 2001 Sep-Oct;87(5):277-87
references: 11765174
references: J Ultrasound Med. 1996 Mar;15(3):241-6
references: 8919506
references: Br J Cancer. 2003 Mar 10;88(5):702-6
references: 12618878
references: Ann Chir Gynaecol. 1990;79(1):15-8
references: 2192685
references: Lancet. 1997 Jun 28;349(9069):1864-7
references: 9217757
references: Eur J Nucl Med. 1996 May;23(5):498-503
references: 8698052
references: Cancer. 1983 Nov 1;52(9):1551-7
references: 6352003
references: Ultraschall Med. 1998 Apr;19(2):70-7
references: 9654672
references: Cancer. 2002 Sep 1;95(5):982-8
references: 12209680
references: Q J Nucl Med Mol Imaging. 2004 Jun;48(2):109-18
references: 15243412
references: J Clin Ultrasound. 1997 Feb;25(2):53-6
references: 9023691
references: Ann Surg. 2002 Nov;236(5):619-24
references: 12409668
references: Ann Surg Oncol. 2004 Sep;11(9):846-53
references: 15313737
references: Eur J Surg Oncol. 1991 Jun;17 (3):240-4
references: 2044777
references: Eur J Surg Oncol. 1996 Apr;22(2):140-3
references: 8608829
references: Breast Cancer Res Treat. 2002 Jan;71(2):171-3
references: 11881913
references: Breast Cancer. 1999 Jul 25;6(3):249-258
references: 11091725
references: AJR Am J Roentgenol. 2001 Apr;176(4):1069-74
references: 11264113
references: Eur J Surg Oncol. 1989 Apr;15(2):139-41
references: 2649395
references: Ann Chir. 2001 Sep;126(7):654-8
references: 11676237
references: Breast Cancer Res Treat. 2005 Jan;89(1):69-74
references: 15666199
references: Am J Surg. 2002 Oct;184(4):307-9
references: 12383889
references: Eur Radiol. 2001;11(12 ):2425-35
references: 11734935
references: World J Surg. 1997 Mar-Apr;21(3):270-4
references: 9015169
references: J Ultrasound Med. 1989 Mar;8(3):115-20
references: 2657088
references: Radiology. 2000 May;215(2):568-73
references: 10796941
references: Radiol Clin North Am. 2000 Jul;38(4):809-23
references: 10943279
references: Radiology. 1997 Dec;205(3):831-5
references: 9393544
references: Ann Surg. 1994 Sep;220(3):391-8; discussion 398-401
references: 8092905
references: Int J Oncol. 2002 Mar;20(3):483-7
references: 11836558