title: Is ultrasound-guided fine-needle aspiration cytology of adequate value in detecting breast cancer patients with three or more positive axillary lymph nodes?
abstract: This study evaluated the accuracy of ultrasound-guided fine-needle aspiration cytology of the sonographically most suspicious axillary lymph node (US/FNAC) to select early breast cancer patients with three or more tumour-positive axillary lymph nodes. Between 2004 and 2014, a total of 2130 patients with histologically proven early breast cancer were evaluated and treated in the Noordwest Clinics Alkmaar. US/FNAC was performed preoperatively in all these patients. We analysed the results of US/FNAC retrospectively. Pathological axillary node status (sentinel node biopsy and/or axillary lymph node dissection) was used as reference standard. A total of 634 (29.8 %) of 2130 patients had axillary lymph node metastases on final histology. 248 node positive patients (11.6 %) had three or more positive lymph nodes. The accuracy of US/FNAC to detect three or more positive lymph nodes was 89.8 %, sensitivity was 44.8 %, specificity was 95.7 %, PPV was 58.1 %, and NPV was 92.9 %. This study shows a more than adequate accuracy of preoperative US/FNAC to detect three or more positive lymph nodes (89.8 %). However, when US/FNAC was chosen as the only axillary staging method, 6.4 % of all patients (false negative group) would have been undertreated and 3.8 % of all patients (false positive group) would have been overtreated according to the ACOSOG Z0011 criteria.
authors.affiliation: Department of Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands. gaellekramer@gmail.com.
authors.forename: G M
authors.initials: GM
authors.lastname: Kramer
authors.affiliation: Department of Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands.
authors.forename: M W H
authors.initials: MW
authors.lastname: Leenders
authors.affiliation: Department of Radiology, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: Schijf
authors.affiliation: Department of Radiology, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands.
authors.forename: H L S
authors.initials: HL
authors.lastname: Go
authors.affiliation: Department of Statistics, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: van der Ploeg
authors.affiliation: Department of Surgery, VU Medical Centre, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
authors.forename: M P
authors.initials: MP
authors.lastname: van den Tol
authors.affiliation: Department of Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands.
authors.forename: W H
authors.initials: WH
authors.lastname: Schreurs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
keywords: Axilla; Breast cancer; FNAC; Fine-needle aspiration cytology; Ultrasound