Node Positivity Among Sonographically Suspicious but FNA-Negative Axillary Nodes

Area of Science:

• Oncology
• Radiology
• Surgical Pathology

Background:

• Fine needle aspiration (FNA) aids breast cancer staging and neoadjuvant therapy decisions.
• Limited data exists for suspicious lymph nodes that are FNA negative.
• This study compares node positivity rates between negative axillary ultrasound (AUSneg) and suspicious ultrasound with negative FNA (FNAneg).

Purpose of the Study:

• To compare the frequency of axillary lymph node positivity.
• To evaluate patients with negative axillary ultrasound (AUSneg) versus suspicious ultrasound with negative FNA (FNAneg).

Main Methods:

• Retrospective analysis of clinically node-negative (cN0) invasive breast cancer patients treated with upfront surgery (2016-2021).
• Comparison of clinicopathologic characteristics and nodal positivity rates between AUSneg and FNAneg groups.
• Analysis included patients undergoing FNA of suspicious lymph nodes.

Main Results:

• 1580 patients analyzed: 1240 AUSneg and 340 FNAneg.
• FNAneg group was younger and had higher clinical T category.
• Axillary pathologic node positivity did not differ significantly (16.5% AUSneg vs. 19.1% FNAneg, p=0.25).

Conclusions:

• Patients with suspicious lymph nodes and negative FNA have a low chance of positive nodes, similar to those with negative ultrasounds.
• Routine targeted excision of FNA-negative clipped nodes is not warranted.
• Findings support current clinical staging and treatment guidance for breast cancer patients.