title: Efficacy of physical examination, ultrasound, and ultrasound combined with fine-needle aspiration for axilla staging of primary breast cancer.
abstract: The aim of this study was to compare the efficacy of physical examination (PE), ultrasound (US), and US combined with fine-needle cytology (US-FNAC) in evaluation of node status before sentinel lymph node biopsy (SLNB) for breast cancer patients. We performed a retrospective study of 3,781 breast cancer patients and calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for PE, US, and US-FNAC, respectively. A total of 3,175 cases were documented as cN0 and 606 as cN1. Abnormal axillary nodes under US were detected in 1,152 cases, among which 821 were proven to have positive nodes by FNAC. The positive FNAC results enabled 11.7% of cN0 patients (373/3,175) to avoid unnecessary SLNB. All 331 cases with abnormal US but negative FNAC results, and the 2,629 cases with normal US underwent SLNB procedure for nodal staging, and metastatic nodes were identified in 745 patients. The sensitivity of PE was 32.2%, with a specificity of 95.5%, a PPV of 83.5%, a NPV of 65%, and an accuracy of 69.3%. The sensitivity, specificity, PPV, NPV, and accuracy of axillary US alone were 58.6, 89.4, 79.6, 75.3, and 76.7%, respectively. Combining axillary US with FNAC resulted in sensitivity, specificity, PPV, NPV, and accuracy of 52.4, 100, 100, 74.8, and 80.3%, respectively. Our study demonstrated that US-FNAC is a feasible and effective triage during axillary staging for newly diagnosed breast cancer patients.
authors: Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Centre, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
authors: Yu
authors: Y
authors: Feng
authors: Rui
authors: R
authors: Huang
authors: Yingjian
authors: Y
authors: He
authors: Aiping
authors: A
authors: Lu
authors: Zhaoqing
authors: Z
authors: Fan
authors: Tie
authors: T
authors: Fan
authors: Meng
authors: M
authors: Qi
authors: Xinguang
authors: X
authors: Wang
authors: Wei
authors: W
authors: Cao
authors: Xing
authors: X
authors: Wang
authors: Yuntao
authors: Y
authors: Xie
authors: Tianfeng
authors: T
authors: Wang
authors: Jinfeng
authors: J
authors: Li
authors: Tao
authors: T
authors: Ouyang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging / Q000601:surgery; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology / Q000648:ultrastructure; D008875:Middle Aged; D009367:Neoplasm Staging; D010808:Physical Examination; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D014463:Ultrasonography