Ultrasound with Biopsy is Highly Accurate in Detection of Axillary Breast Cancer Metastases
“Axillary ultrasound with FNAB has an accuracy of >70% in this series,” wrote Jonathan Cools-Lartigue, MD, of the Department of Surgery at McGill University Health Center, in Montreal, Canada, and coauthors. “It is easily performed and may avoid unnecessary sentinel lymph node biopsy in a significant number of patients.”
Sentinel lymph node biopsy “has supplanted axillary node dissection as the gold standard in the operative nodal staging of carcinoma of the breast,” the authors note. In light of controversy over the role of axillary lymph node dissection after sentinel lymph node biopsy, the authors assessed the sensitivity, specificity, and accuracy of axillary ultrasound with and without FNAB in the detection of axillary nodal metastasis in 235 patients with Stage I and II breast cancer.
No patients exhibited more than two positive sentinel lymph nodes. Ultrasound alone demonstrated a sensitivity of 55% and specificity of 88%, but adding FNAB improved sensitivity to 69% and specificity to 100%, the authors reported.
“Predictors of abnormal ultrasound included size of metastasis, estrogen receptor and Her-2 status, tumor grade, and presence of lymphovascular invasion,” they noted. “In conjunction with FNAB, the positive and negative predictive values were 100 and 54 %, respectively. Ten percent of patients with nodal metastases demonstrated a positive FNAB. Patients with a positive FNAB did not harbor more nodal metastases or a greater proportion of gross extranodal disease compared to patients not subjected to FNAB.”