Axillary ultrasound in invasive breast cancer: experience of our surgeons

Preoperative axillary ultrasound (USS) and fine needle aspiration cytology (FNAC) may allow diagnosis of axillary metastases and reduce repeat axillary procedures. This procedure is usually performed by radiologists. The aim of this prospective study was to evaluate the diagnostic accuracy of surgeon performed axillary USS and/or FNAC in determining axillary nodal status preoperatively. Patients with invasive breast cancer from August 2007 to July 2008 were studied prospectively. Patients who had primary hormonal therapy, neo-adjuvant therapy or distant metastases were excluded. Axillary USS was performed by two consultant breast surgeons trained in ultrasound and biopsy techniques. USS guided FNAC was used to evaluate suspicious nodes. Those with positive cytology (i.e., malignant cells) underwent axillary clearance and the remainder had either sentinel lymph node biopsy or axillary node sample. Axillary USS and FNAC results were compared with final axillary histology. One hundred and twenty eight patients were included with a mean age of 60 years. Nodes were nonpalpable in 96(75%) patients. Forty nine(38.2%) patients had axillary metastases on final histology and 30 of the 49(61%) were identified by preoperative USS guided FNAC. The sensitivity and specificity of this procedure were 61% and 100%, respectively. The positive predictive value and negative predictive value were 100% and 80.6%, respectively. Therefore, 61% of patients with axillary metastases were able to proceed directly to definitive axillary surgery. The use of USS and FNAC to evaluate and sample the axillary nodes in patients with invasive breast cancer can be a useful tool for the breast surgeon.