Accuracy of Preoperative Ultrasound-Guided Axillary
Lymph Node Core Needle Biopsy to Predict Axillary
Lymph Node Involvement in Breast Cancer
Premkamol Patraithikul MD¹, Wilairat Prasert MD², Wanrudee Lohitvisate MD³
Affiliation : ¹ Department of General Surgery, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand ² Division of Head Neck Breast Surgery, Department of General Surgery, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand ³ Division of Breast Imaging, Department of Diagnostic Radiology, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
Background: Breast cancer operative management consists of breast surgery and axillary lymph node (ALN) assessment. ALN status is an
important prognostic factor and determinant of breast cancer treatment.
Objective: To investigate preoperative ultrasound-guided axillary lymph node core needle biopsy (USACNB) accuracy in predicting ALN involvement for breast cancer.
Materials and Methods: This retrospective cohort study took place between February 2014 and May 2019. One hundred nine consecutive operable breast cancer patients with suspicious ALN involvement were assessed using preoperative USACNB and subsequent breast cancer surgery. Exclusion criteria were insufficient ALN tissue from USACNB for interpretation, previous breast or axillary surgery on the same side. Patients with preoperative histopathology results proving of metastasis underwent ALN dissection (ALND) while those with negative results had sentinel lymph node biopsy (SLNB). When SLNB was positive, ALND was then performed. Preoperative USACNB accuracy was analyzed using SLNB or ALND pathological results as standard tests.
Results: The sensitivity, specificity, PPV, and NPV of preoperative USACNB in evaluating ALN involvement was 87.5%, 100%, 100%, and 80.4%, respectively, with an accuracy of 91.7%.
Conclusion: Preoperative USACNB shows high diagnostic accuracy in ALN metastasis, but its NPV remains too low to completely rule out ALN involvement. Standard SLNB is still necessary in cases of negative USACNB.
Received 22 February 2021 | Revised 19 April 2021 | Accepted 20 April 2021
doi.org/10.35755/jmedassocthai.2021.06.12423
Keywords :
Breast cancer; Ultrasound guided core needle biopsy; Axillary lymph node
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