Audit of ultrasound guided core needle biopsies of ipsilateral axiliary lymph nodes in breast cancer

Abstract

INTRODUCTION: The most essential prognostic factor in the management of primary breast cancer patients is the involvement of axillary lymph nodes. Ultrasound-guided core needle biopsy (US-guided CNB) of lymph nodes is a simple and minimally invasive technique used to stage the axilla. AIM: This study aims to establish the clinical usefulness and the diagnostic accuracy of US-guided CNB in targeting metastatic axillary lymph nodes. METHOD: This study is a retrospective review of US-guided CNB of ipsilateral axillary lymph nodes in breast cancer patients. Nodal ultrasound findings were considered suspicious for metastases when one of the following features was visualized: nodal enlargement (>2cm), cortical thickening (>3mm), loss of fatty hilum and non-hilar blood flow (NHBF). US-guided CNB histopathological were compared to axillary lymph node dissection (ALND) histology results for diagnostic accuracy. RESULTS: Axillary nodal metastases were found by US-guided CNB in 120/132 (90,9%) patients. Axillary lymph node dissection was performed in 63/130 (48,4%) patients, 56/63 (88,8%) and 7/63 (11,1%) of these patients had positive and negative US-guided CNB results respectively. In this study, there were no false-positive results, the false-negative result was 1/7. It was found that NHBF had a PPV of 89,8% (p=0,05), identifying a significant difference between histologically involved and non-involved nodes. Among the US-depicted abnormalities, thickening of the cortex had the highest sensitivity 91/118 (77,1%), followed by the absence of fatty hilum 84/119 (70.6%) whereas the size of the node had the highest specificity 36/37 (97,3%). CONCLUSIONS: Axillary lymph nodes in breast cancer patients can be sampled with high accuracy using the US-guided CNB technique