title: A Positive Node on Ultrasound-Guided Fine Needle Aspiration Predicts Higher Nodal Burden Than a Positive Sentinel Lymph Node Biopsy in Breast Carcinoma.
abstract: Axillary status remains an important prognostic indicator in breast cancer. Certain patients with a positive sentinel node (SLNB) may not benefit from axillary clearance (AC). Uncertainty remains if this approach could be applied to patients diagnosed with axillary metastases on ultrasound-guided fine needle aspiration cytology (USFNAC). The aim of this study was to compare nodal burden in patients with positive USFNAC and a positive SLNB.
  
  
  
  A retrospective study was performed involving all BC patients between 2007 and 2014 who had either pre-operative USFNAC or a SLNB. Patient/tumour characteristics and nodal burden were examined in all patients proceeding to AC.
  
  
  
  974 patients were eligible for analysis. 439 patients (45 %) had positive USFNAC and 535 (55 %) had a positive SLNB. USFNAC-positive patients were more likely to undergo mastectomy (Chi-square test; p < 0.001), have extra-nodal extension (p < 0.001), be oestrogen receptor negative (p < 0.001) and be HER2 positive (p < 0.001). The median total number of lymph nodes (LNs) excised during AC was higher in the USFNAC group (Mann-Whitney test; 23 vs. 21; p < 0.001). The median total number of involved LNs was 3 (range 1-47) in FNAC-positive patients versus 1 (range 1-37) in SLNB-positive patients (p < 0.001). The median number of involved LNs in level 1 was 3 in FNAC-positive patients versus 1 in SLNB-positive patients (p < 0.001). Within the SLN-positive group, 49 % of the patients had only one involved LN, 28 % had two nodes involved and 23 % had ≥3. In comparison, within the FNAC-positive group only 13 % of the patients had one involved LN, 12 % had two nodes involved and 74 % had ≥3.
  
  
  
  Patients with positive USFNAC have more aggressive clinico-pathological characteristics and higher nodal burden compared to SLNB-positive patients. Currently, the authors advocate that patients not receiving neoadjuvant chemotherapy, with a positive USFNAC, should proceed directly to an axillary ALND.
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland. michaelboland@rcsi.ie.
authors.forename: M R
authors.initials: MR
authors.lastname: Boland
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Ni Cearbhaill
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Fitzpatrick
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: S M
authors.initials: SM
authors.lastname: Walsh
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Evoy
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Geraghty
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Rothwell
authors.affiliation: The Department of Radiology, St.Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: McNally
authors.affiliation: The Department of Radiology, St.Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: O'Doherty
authors.affiliation: The Department of Pathology, St.Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: C M
authors.initials: CM
authors.lastname: Quinn
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: E W
authors.initials: EW
authors.lastname: McDermott
authors.affiliation: The Department of Breast and Endocrine Surgery, St.Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: R S
authors.initials: RS
authors.lastname: Prichard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D018084:Ultrasonography, Interventional; D055815:Young Adult