title: [Axillary lymph node aspiration guided by ultrasound is effective as a method of predicting lymph node involvement in patients with breast cancer?].
abstract: OBJECTIVE
  To assess the feasibility and diagnostic accuracy of preoperative ultrasound combined with ultrasound-guided fine-needle aspiration (US-FNA) cytology and clinical examination of axillary lymph node in patients with breast cancer.
  
  
  METHODS
  In this prospective study, 171 axillae of patients with breast cancer were evaluated by clinical examination and ultrasonography (US) with and without fine needle aspiration (FNA). Lymph nodes with maximum ultrasonographic cortical thickness > 2.3 mm were considered suspicious and submitted to US-FNA.
  
  
  RESULTS
  Logistic regression analysis showed no statistically significant correlation between clinical examination and pathologically positive axillae. However, in axillae considered suspicious by ultrasonography, the risk of positive anatomopathological findings increased 12.6-fold. Cohen's Kappa value was 0.12 for clinical examination, 0.48 for US, and 0.80 for US-FNA. Accuracy was 61.4% for clinical examination, 73.1% for US and 90.1% for US-FA. Receiver Operating Characteristics (ROC) analysis demonstrated that a cortical thickness of 2.75 mm corresponded to the highest sensitivity and specificity in predicting axillary metastasis (82.7 and 82.2%, respectively).
  
  
  CONCLUSIONS
  Ultrasonography combined with fine-needle aspiration is more accurate than clinical examination in assessing preoperative axillary status in women with breast cancer. Those who are US-FNA positive can be directed towards axillary lymph node dissection straight away, and only those who are US-FNA negative should be considered for sentinel lymph node biopsy.
authors.affiliation: Centro de Avaliação em Mastologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.
authors.forename: Eduardo Carvalho
authors.initials: EC
authors.lastname: Pessoa
authors.affiliation: Departamento de Ginecologia Obstetrícia e Mastologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.
authors.forename: José Ricardo Paciência
authors.initials: JR
authors.lastname: Rodrigues
authors.affiliation: Centro de Ciências da Saúde, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil.
authors.forename: Carla Priscila Kamiya Carvalho
authors.initials: CP
authors.lastname: Pessoa
authors.affiliation: Departamento de Ginecologia Obstetrícia e Mastologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.
authors.forename: Heloísa Maria de Luca
authors.initials: HM
authors.lastname: Véspoli
authors.affiliation: Departamento de Ginecologia Obstetrícia e Mastologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Uemura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D014463:Ultrasonography