title: Diagnostic Accuracy and Impact on Management of Ultrasonography-Guided Fine-Needle Aspiration to Detect Axillary Metastasis in Breast Cancer Patients: A Prospective Study.
abstract: BACKGROUND
  The axillary nodal status is essential to determine the stage of disease at diagnosis. Our aim was to prospectively assess the diagnostic accuracy of ultrasonography-guided fine-needle aspiration (US-FNA) for the detection of metastasis in axillary lymph nodes in patients with breast cancer (BC) and its impact on the therapeutic decision.
  
  
  METHODS
  Ultrasonography (US) was performed in 407 axillae of 396 patients who subsequently underwent surgery. US-FNA was conducted when lymph nodes were detected by US. Axillary dissection (AD) was performed when US-FNA was positive for metastasis. Patients with negative US-FNA and breast tumors of 30 mm in size were candidates for selective sentinel lymph node biopsy (SLNB). The anatomopathological results of AD or SLNB were used as reference tests.
  
  
  RESULTS
  Lymph nodes were detected by US in 207 (50.8%) axillae. Of these, US-FNA was performed on 180 (86.9%). 94 axillae (52.2%) were positive for carcinoma and 79 women received AD. US-FNA had 77.5% sensitivity, 100% specificity, 100% positive predictive value, 69.3% negative predictive value, and 85.1% diagnostic accuracy. US-FNA avoided SLNB in 18.1% of patients who underwent AD.
  
  
  CONCLUSIONS
  Axillary US-FNA is an accurate technique in the staging of patients with BC. It allows reducing the number of SLNB and, when positive, offers a fast and useful tool.
authors.affiliation: Department of Radiology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Diaz-Ruiz
authors.affiliation: Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Arnau
authors.affiliation: Clinical Research Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Montesinos
authors.affiliation: Department of Oncology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Miguel
authors.affiliation: Breast Cancer Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Culell
authors.affiliation: Breast Cancer Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Solernou
authors.affiliation: UDIAT-CD, Corporació Sanitària Parc Taulí, Sabadell, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Tortajada
authors.affiliation: Department of Anatomopathology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vergara
authors.affiliation: Department of Radiology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Yanguas
authors.affiliation: Department of Medicine, Universitat Autònoma de Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Salvador-Tarrasón
keywords: Fine-needle aspiration biopsy; Lymph node status; Staging; Treatment strategies; Ultrasound