title: Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients.
abstract: OBJECTIVE
  Roughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement.
  
  
  METHODS
  Between January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required.
  
  
  RESULTS
  1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%.
  
  
  CONCLUSIONS
  We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Barco
authors.affiliation: Department of Nursing, School of Health Science, TecnoCampus Mataró-Maresme, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Chabrera
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain. drgarciafdez@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: García-Fernández
authors.affiliation: Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fraile
authors.affiliation: Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.
authors.forename: S
authors.initials: S
authors.lastname: González
authors.affiliation: Breast Unit, Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Canales
authors.affiliation: Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Lain
authors.affiliation: Department of Pathology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.
authors.forename: C
authors.initials: C
authors.lastname: González
authors.affiliation: Department of Nursing, Promotion and Supporting Program, Institut Català de la Salut, ASSIR Mollet, Barcelona, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Vidal
authors.affiliation: Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Vallejo
authors.affiliation: Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Deu
authors.affiliation: Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pessarrodona
authors.affiliation: University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.|Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Giménez
authors.affiliation: University International of Catalunya, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: García Font
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging*; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D014218:Triage / Q000379:methods; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: Axillary ultrasound; Breast neoplasms; Fine-needle aspiration; Magnetic resonance imaging; Sensitivity and specificity; Sentinel lymph node biopsy