title: Preoperative axillary ultrasound and fine-needle aspiration biopsy in the diagnosis of axillary metastases in patients with breast cancer: predictors of accuracy and future implications.
abstract: BACKGROUND
  The utility of axillary lymph node dissection after sentinel lymph node biopsy has been called into question. We sought to determine the sensitivity, specificity, and accuracy of axillary ultrasound and fine-needle aspiration biopsy (FNAB) in the identification of axillary nodal metastasis in early breast cancer patients.
  
  
  METHODS
  Data of patients with stage I and II breast cancer who underwent surgery and staging were reviewed. Axillary ultrasound findings were assessed and lymph node status recorded after axillary dissection. The data were cross-tabulated, and test characteristics were calculated.
  
  
  RESULTS
  Of 235 patients, none demonstrated more than 2 positive sentinel lymph nodes. Ductal carcinoma was present in 68%, estrogen and progesterone receptors were positive in 81 and 64%, respectively, Her-2/neu was positive in 10%, and 36% were axillary node positive. The sensitivity and specificity of ultrasound alone were 55 and 88%, respectively. Predictors of abnormal ultrasound included size of metastasis, estrogen receptor and Her-2 status, tumor grade, and presence of lymphovascular invasion. Addition of FNAB increased the sensitivity and specificity to 69 and 100%. In conjunction with FNAB, the positive and negative predictive values were 100 and 54%, respectively. Ten percent of patients with nodal metastases demonstrated a positive FNAB. Patients with a positive FNAB did not harbor more nodal metastases or a greater proportion of gross extranodal disease compared to patients not subjected to FNAB.
  
  
  CONCLUSIONS
  Axillary ultrasound with FNAB has an accuracy of >70% in this series. It is easily performed and may avoid unnecessary sentinel lymph node biopsy in a significant number of patients.
authors.affiliation: Department of Surgery, McGill University Health Centre, Montreal, QC, Canada. jonathan.cools-lartigue@mail.mcgill.ca
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cools-Lartigue
authors.forename: Alison
authors.initials: A
authors.lastname: Sinclair
authors.forename: Nora
authors.initials: N
authors.lastname: Trabulsi
authors.forename: Ari
authors.initials: A
authors.lastname: Meguerditchian
authors.forename: Benoit
authors.initials: B
authors.lastname: Mesurolle
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fuhrer
authors.forename: Sarkis
authors.initials: S
authors.lastname: Meterissian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001365:Axilla; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis*; D018275:Carcinoma, Lobular / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D016217:Ultrasonography, Mammary; D055815:Young Adult
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases