title: Ultrasound and fine needle aspiration cytology of the axilla in the pre-operative identification of axillary nodal involvement in breast cancer.
abstract: OBJECTIVE
  Pre-operative diagnosis of axillary nodal involvement in breast cancer allows one-stage axillary surgery. We evaluated the efficacy of axillary ultrasound (US) with US guided fine needle aspiration cytology (FNAC) in the diagnosis of axillary nodal involvement.
  
  
  METHODS
  Over a 13-month period, we performed US of 369 axillae in patients with screen-detected (n = 278) and symptomatic (n = 91) invasive carcinoma of the breast, at the same time as US of the primary tumour. If abnormal lymph nodes were demonstrated, a single US guided FNAC of the most abnormal node was performed. US and FNAC results were compared with the final histology of the surgically excised lymph nodes.
  
  
  RESULTS
  Among the 369 axillae studied, 102 had nodal macrometastases and 38 (37%) were identified by US guided FNAC. The rate was 33% in screen-detected and 44% in symptomatic patients. Sensitivity increased with increasing numbers of positive axillary nodes, and the more abnormal the appearances of the nodes on US.
  
  
  CONCLUSIONS
  US with FNAC of the most abnormal node allows pre-operative detection of a third of node positive axillae in screen-detected and over 40% of those with symptomatic breast cancer, allowing one-stage axillary surgery avoiding the sentinel node biopsy step in these patients.
authors.affiliation: Bedfordshire and Hertfordshire Breast Screening Unit and Luton & Dunstable Breast Unit, Luton & Dunstable Hospital NHS Foundation Trust, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK.
authors.forename: C
authors.initials: C
authors.lastname: Swinson
authors.forename: D
authors.initials: D
authors.lastname: Ravichandran
authors.forename: M
authors.initials: M
authors.lastname: Nayagam
authors.forename: S
authors.initials: S
authors.lastname: Allen
mesh_terms: D000328:Adult; D001365:Axilla / Q000000981:diagnostic imaging / Q000473:pathology; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D011300:Preoperative Care; D011446:Prospective Studies; D018084:Ultrasonography, Interventional