title: Fine needle aspiration cytology of lymph nodes in breast cancer follow-up is a feasible alternative to watchful waiting and to histology.
abstract: BACKGROUND
  Early detection of loco-regional breast cancer recurrence improves patients' overall survival, as treatment can be initiated or active treatment can be changed. If a suspicious lymph node is diagnosed during a follow-up exam, surgical excision is often performed. The aim of this study was to evaluate the diagnostic performance of the minor invasive ultrasound-guided fine-needle aspiration cytology (FNAC) in sonomorphologically suspicious lymph nodes in breast cancer follow-up.
  
  
  METHODS
  Between April 2010 and November 2012, we performed ultrasound-guided FNAC in 38 sonographically suspicious lymph nodes of 37 breast cancer follow-up patients. Cytological specimens were evaluated if the sample material was sufficient for diagnosis and if they contained cancer cells. Patients with negative cytology were followed up clinically and sonographically. To evaluate the diagnostic performance we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for physical examination, the different sonomorphological malignancy criteria and FNAC.
  
  
  RESULTS
  In 36/38 (94.7 %) lymph nodes, the pathologist had enough material to establish a final diagnosis; in 2/38 (5.3 %) lymph nodes, the probe material was non-evaluable during cytology, these 2 were excluded from further statistical evaluation. Cytology revealed malignancy in 21 lymph nodes and showed no evidence for malignancy in 15 lymph nodes. There was no evidence for malignant disease in follow-up exams in the 15 cytologically benign lymph nodes with an average follow-up time of 3 years. The diagnostic performances of physical examination and FNAC were: Sensitivity 52/100 %, specificity 88/100 %, PPV 85/100 %, NPV 60/100 %, respectively.
  
  
  CONCLUSIONS
  Our preliminary results show that FNAC is a safe and fast diagnostic approach for the evaluation of suspicious lymph nodes in the follow-up of patients with breast cancer and, thus, together with follow-up represents a feasible alternative to surgery.
authors.affiliation: Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany. matthias.hammon@uk-erlangen.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hammon
authors.affiliation: Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany. peter.dankerl@uk-erlangen.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Dankerl
authors.affiliation: Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany. rolf.janka@uk-erlangen.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Janka
authors.affiliation: Department of Pathology, University Hospital Erlangen, Erlangen, Germany. david.wachter@uk-erlangen.de.
authors.forename: David L
authors.initials: DL
authors.lastname: Wachter
authors.affiliation: Department of Pathology, University Hospital Erlangen, Erlangen, Germany. arndt.hartmann@uk-erlangen.de.
authors.forename: Arndt
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany. ruediger.schulz-wendtland@uk-erlangen.de.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schulz-Wendtland
authors.affiliation: Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany. michael.uder@uk-erlangen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.affiliation: Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany. evelyn.wenkel@uk-erlangen.de.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Wenkel
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003581:Cytodiagnosis / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D057832:Watchful Waiting / Q000592:standards