Suvi Hanne Katriina Rautiainen MD, Abstract Co-Author: Nothing to Disclose

Mazen Sudah MD, Abstract Co-Author: Nothing to Disclose

Outi Pelkonen PhD, Abstract Co-Author: Nothing to Disclose

Anna Sutela, Abstract Co-Author: Nothing to Disclose

Sinikka Aukee MD, Abstract Co-Author: Nothing to Disclose

Amro Masarwah MD, Presenter: Nothing to Disclose

Ritva Liisa Vanninen MD, Abstract Co-Author: Nothing to Disclose

The most significant prognostic factor in invasive breast cancer is the presence of axillary metastasis. Preoperative axillary ultrasound (US) often aids to identify pathologic lymph nodes yet with low sensitivity and specificity. Therefore US-guided needle biopsy is needed to confirm or rule out metastasis. In the literature, core biopsy (CB) results are slightly superior to fine needle aspiration (FNA) but the difference was not statistically significant in a recent meta-analysis. Nevertheless, no prospective comparative studies of these two biopsy methods are available in the same patient population. The purpose of this ongoing study was to compare the accuracy of axillary FNA vs. CB in the preoperative evaluation of patients with invasive breast cancer.

Altogether 120 consecutive newly diagnosed invasive breast cancer patients (124 axillae) were included in this prospective single centre study between April 2011 and March 2012. A lymph node was considered suspicious if the cortex was >2 mm thick or had pathologic morphology. The most suspicious lymph node was biopsied both with FNA followed by CB (16G). Patients with positive findings were triaged directly to axillary lymph node dissection, while the negative proceeded to sentinel lymph node biopsy.

Based on the final histopathology 52 axillae (41,9%) proved to have metastasis. Altogether 44 axillae were preoperatively biopsied. The sensitivity of CB (90,6%) was significantly higher than that of FNA (71,9%, P=0,031) while both had 100% specificity. Negative predictive value was 57,1% for FNA and 80,0% for CB. Overall accuracy was 79,5% for FNA and 93,2% for CB. No significant complications were reported for CB.

US-guided axillary lymph node CB has a greater sensitivity than FNA for detecting axillary lymph node metastasis and should therefore be advocated for preoperative axillary staging.

Ultrasound guided axillary lymph node CB is a feasible and accurate diagnostic procedure in the preoperative staging of invasive breast cancer patients. Cost-effectiveness needs further evaluation.

Rautiainen, S, Sudah, M, Pelkonen, O, Sutela, A, Aukee, S, Masarwah, A, Vanninen, R, Axillary Lymph Node Biopsy in Newly Diagnosed Breast Cancer: Comparative Accuracy of Fine Needle Aspiration vs Core Biopsy.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12022835.html