title: Axillary ultrasound and fine-needle aspiration in preoperative staging of axillary lymph nodes in patients with invasive breast cancer.
abstract: OBJECTIVE
  To propose an algorithm to determine the necessity for ultrasonography-guided fine-needle aspiration (US-FNA) in preoperative axillary lymph node staging of patients with invasive breast cancer.
  
  
  METHODS
  Prospective study developed at National Cancer Institute. The study sample included 100 female patients with breast cancer referred for axillary staging by US-FNA.
  
  
  RESULTS
  The overall US-FNA sensitivity was set at 79.4%. The positive predictive value was calculated to be 100%, and the negative predictive value, 69.5%. The US-FNA sensitivity for lymph nodes with normal sonographic features was 0%, while for indeterminate lymph nodes it was 80% and, for suspicious lymph nodes, 90.5%. In the assessment of invasive breast tumors stages T1, T2 and T3, the sensitivity was respectively 69.6%, 83.7% and 100%. US-FNA could avoid sentinel node biopsy in 54% of cases.
  
  
  CONCLUSIONS
  Axillary ultrasonography should be included in the preoperative staging of all patients with invasive breast cancer. The addition of US-FNA in cases of lymph nodes suspicious for malignancy may prevent more than 50% of sentinel lymphadenectomies, significantly shortening the time interval to definitive therapy.
authors.affiliation: MD, Radiologist, Trainee in Interventional Radiology at Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Rafael Dahmer
authors.initials: RD
authors.lastname: Rocha
authors.affiliation: MD, Radiologist, Trainee in General Radiology at Med Imagem - Real e Benemérita Sociedade Portuguesa de Beneficência, São Paulo, SP, Brazil.
authors.forename: André Ricardo
authors.initials: AR
authors.lastname: Girardi
authors.affiliation: MD, Breast Specialist, Hospital do Câncer III - Instituto Nacional de Câncer - Ministério da Saúde (INCA-MS), Rio de Janeiro, RJ, Brazil.
authors.forename: Renata Reis
authors.initials: RR
authors.lastname: Pinto
authors.affiliation: MD, Radiologist, Hospital do Câncer III - Instituto Nacional de Câncer - Ministério da Saúde (INCA-MS), Rio de Janeiro, RJ, Brazil.
authors.forename: Viviane Aguilera Rolim
authors.initials: VA
authors.lastname: de Freitas
keywords: Axillary lymph node; Breast cancer; Fine-needle aspiration; Ultrasound
references.citation: Adv Surg. 2011;45:101-16
references.pmid: 21954681
references.citation: Eur J Cancer. 2003 May;39(8):1068-73
references.pmid: 12736105
references.citation: Eur J Surg Oncol. 2008 May;34(5):497-500
references.pmid: 17845836
references.citation: Eur J Cancer. 2003 Jan;39(2):170-4
references.pmid: 12509948
references.citation: Radiol Bras. 2014 Jul-Aug;47(4):240-4
references.pmid: 25741091
references.citation: Br J Surg. 1999 Nov;86(11):1459-62
references.pmid: 10583296
references.citation: CA Cancer J Clin. 2006 Jan-Feb;56(1):37-47; quiz 50-1
references.pmid: 16449185
references.citation: Surg Today. 2007;37(9):735-9
references.pmid: 17713725
references.citation: AJR Am J Roentgenol. 2010 Nov;195(5):1261-7
references.pmid: 20966338
references.citation: Br J Cancer. 2003 Mar 10;88(5):702-6
references.pmid: 12618878
references.citation: Br J Radiol. 2008 Aug;81(968):630-6
references.pmid: 18628332
references.citation: Radiol Clin North Am. 2010 Sep;48(5):989-97
references.pmid: 20868896
references.citation: Am J Surg. 2008 Oct;196 (4):477-82
references.pmid: 18723153
references.citation: Ann Surg Oncol. 2008 Feb;15(2):462-71
references.pmid: 17985188
references.citation: Cancer. 2002 Sep 1;95(5):982-8
references.pmid: 12209680
references.citation: Vojnosanit Pregl. 2012 May;69(5):414-9
references.pmid: 22764544
references.citation: Radiology. 2008 Jan;246(1):81-9
references.pmid: 17991784
references.citation: ANZ J Surg. 2010 Apr;80(4):271-5
references.pmid: 20575955
references.citation: J Clin Oncol. 2005 Jul 1;23(19):4312-21
references.pmid: 15994144
references.citation: Breast. 2009 Apr;18(2):119-22
references.pmid: 19297159
references.citation: Ann Surg Oncol. 2006 Jan;13(1):31-5
references.pmid: 16372147
references.citation: Cancer. 2009 Dec 25;117(6):451-62
references.pmid: 19813277
references.citation: AJR Am J Roentgenol. 2006 May;186(5):1342-8
references.pmid: 16632729
references.citation: Am J Surg. 2002 Oct;184(4):307-9
references.pmid: 12383889
references.citation: Ann Surg Oncol. 2011 Mar;18(3):738-44
references.pmid: 20890729
references.citation: Rev Bras Ginecol Obstet. 2014 Mar;36(3):118-23
references.pmid: 24728315
references.citation: J Am Coll Surg. 2005 Jan;200(1):10-4
references.pmid: 15631914
references.citation: Surg Oncol. 1993 Dec;2(6):335-9; discussion 340
references.pmid: 8130940
references.citation: Ann Surg. 2010 Sep;252(3):426-32; discussion 432-3
references.pmid: 20739842
references.citation: J Am Coll Surg. 2001 Dec;193(6):593-600
references.pmid: 11768674
references.citation: J Oncol. 2012;2012:361341
references.pmid: 22927845
references.citation: Am J Surg. 2006 Oct;192(4):458-61
references.pmid: 16978949