Scientific Presentation Award: The combination of axillary ultrasound and ultrasound-guided biopsy is an accurate predictor of axillary stage in clinically node-negative breast cancer patients

Holwitt, Dana M.; Swatske, Mary Ellen; Gillanders, William E.; Monsees, Barbara S.; Gao, Feng; Aft, Rebecca L.; Eberlein, Timothy J.; Margenthaler, Julie A.

doi:10.1016/j.amjsurg.2008.06.006

« Previous Next »The American Journal of Surgery
Volume 196, Issue 4 , Pages 477-482, October 2008

Scientific Presentation Award: The combination of axillary ultrasound and ultrasound-guided biopsy is an accurate predictor of axillary stage in clinically node-negative breast cancer patients

Dana M. Holwitt, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
Mary Ellen Swatske, R.N.
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
William E. Gillanders, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
Barbara S. Monsees, M.D.
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
Feng Gao, Ph.D.
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
Rebecca L. Aft, M.D., Ph.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
- Department of Surgery, John Cochran Veterans Hospital, St. Louis, MO, USA
Timothy J. Eberlein, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
Julie A. Margenthaler, M.D.
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA
- Corresponding author. Tel.: +1-314-747-9724; fax: +1-314-454-5509

Received 12 April 2008; received in revised form 1 June 2008 published online 26 August 2008.

Abstract

Background

The study aim was to determine the accuracy of axillary ultrasound (AUS) and fine-needle aspiration biopsy (FNAB)/needle core biopsy in axillary breast cancer staging.

Methods

We reviewed 256 patients with clinically node-negative breast cancer who underwent AUS ± FNAB/needle core biopsy. AUS-guided FNAB/needle core biopsy was compared with histopathology to determine sensitivity, specificity, negative predictive value, and positive predictive value.

Results

AUS-guided FNAB/needle core biopsy and final pathology were positive in 72 of 256 patients (28%). In 125 of 256 cases (49%), the AUS and final pathology were negative. Two of 110 patients had a false-positive FNAB (1.8%); both received neoadjuvant chemotherapy. Nine patients (8%) had a false-negative FNAB/needle core biopsy; the median size of lymph node metastasis was 3 mm. The sensitivity and specificity of AUS-guided FNAB/needle core biopsy was 71% and 99%, respectively, with a negative predictive value of 84% and a positive predictive value of 97%.

Conclusions

AUS-guided FNAB/needle core biopsy is accurate in predicting the status of the axilla in 70% of clinically node-negative breast cancer patients. This technique is minimally invasive with a low complication rate and can obviate the need for staged lymph node procedures.

Keywords: Breast cancer, Axillary ultrasound, Fine-needle aspiration biopsy