Susan Lyn Koelliker MD, Presenter: Nothing to Disclose

Maureen Chung MD, Abstract Co-Author: Nothing to Disclose

Margaret Steinhoff MD, Abstract Co-Author: Nothing to Disclose

Martha Beretta Mainiero MD, Abstract Co-Author: Nothing to Disclose

Blake Cady MD, Abstract Co-Author: Nothing to Disclose

The objective of this study was to compare axillary ultrasound (US) and ultrasound guided fine needle aspiration of axillary lymph nodes (USFNA) for axillary lymph node staging in breast cancer patients

79 consecutive breast cancer patients with sonographically visible axillary lymph nodes who underwent USFNA for initial staging were retrospectively reviewed. Size of the primary breast cancer ranged from 1.1-10 cm (mean 4 cm). Lymph nodes were classified based on sonographic characteristics as benign, malignant or indeterminate. USFNA of the most sonographically suspicious node, or the largest if all appeared benign, was performed. Final pathology (sentinel lymph node biopsy or axillary lymph node dissection) was correlated with US and with pre-operative USFNA.

52 patients had nodal disease after surgical staging. The accuracy of US and USFNA for determining lymph node status was 60.5% and 72.2%, respectively. The sensitivity and specificity of US for evaluating axillary disease were 67.9% and 64%. The sensitivity and specificity of USFNA was 71.4% and 88.9%. 61.5% of the false negative patients of USFNA had nodal disease less than 5mm after surgical staging, and 23.1% had micrometastases. Of the 31 lymph nodes that had a benign ultrasound appearance, 7 (22.6%) were positive on USFNA.

Sonographic assessment of axillary lymph nodes can be improved when coupled with fine needle aspiration. Sonographically normal appearing axillae have a significant positive rate (22.6%) when USFNA is performed. USFNA can predict the majority of positive axillae, and should be performed on patients with large tumors (>3cm) as it may obviate the need for sentinel node biopsy when positive.

Koelliker, S, Chung, M, Steinhoff, M, Mainiero, M, Cady, B, Ultrasound and Fine Needle Aspiration of Axillary Lymph Nodes in Initial Staging of Breast Cancer.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4407174.html