Breast Cancer Research and Treatment

, Volume 156, Issue 2, pp 271–278 | Cite as

Is ultrasound-guided fine-needle aspiration cytology of adequate value in detecting breast cancer patients with three or more positive axillary lymph nodes?

  • G. M. Kramer
  • M. W. H. Leenders
  • L. J. Schijf
  • H. L. S. Go
  • T. van der Ploeg
  • M. P. van den Tol
  • W. H. Schreurs
Preclinical study


This study evaluated the accuracy of ultrasound-guided fine-needle aspiration cytology of the sonographically most suspicious axillary lymph node (US/FNAC) to select early breast cancer patients with three or more tumour-positive axillary lymph nodes. Between 2004 and 2014, a total of 2130 patients with histologically proven early breast cancer were evaluated and treated in the Noordwest Clinics Alkmaar. US/FNAC was performed preoperatively in all these patients. We analysed the results of US/FNAC retrospectively. Pathological axillary node status (sentinel node biopsy and/or axillary lymph node dissection) was used as reference standard. A total of 634 (29.8 %) of 2130 patients had axillary lymph node metastases on final histology. 248 node positive patients (11.6 %) had three or more positive lymph nodes. The accuracy of US/FNAC to detect three or more positive lymph nodes was 89.8 %, sensitivity was 44.8 %, specificity was 95.7 %, PPV was 58.1 %, and NPV was 92.9 %. This study shows a more than adequate accuracy of preoperative US/FNAC to detect three or more positive lymph nodes (89.8 %). However, when US/FNAC was chosen as the only axillary staging method, 6.4 % of all patients (false negative group) would have been undertreated and 3.8 % of all patients (false positive group) would have been overtreated according to the ACOSOG Z0011 criteria.


Breast cancer Axilla Ultrasound Fine-needle aspiration cytology FNAC 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict.

Ethical approval

This study was conducted according to the principles of the declaration of Helsinki (2008) and in accordance with the Medical Research Involving Human Subjects Act (Dutch: WMO).


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • G. M. Kramer
    • 1
  • M. W. H. Leenders
    • 1
  • L. J. Schijf
    • 2
  • H. L. S. Go
    • 2
  • T. van der Ploeg
    • 3
  • M. P. van den Tol
    • 4
  • W. H. Schreurs
    • 1
  1. 1.Department of SurgeryNoordwest Clinics AlkmaarAlkmaarThe Netherlands
  2. 2.Department of RadiologyNoordwest Clinics AlkmaarAlkmaarThe Netherlands
  3. 3.Department of StatisticsNoordwest Clinics AlkmaarAlkmaarThe Netherlands
  4. 4.Department of SurgeryVU Medical CentreAmsterdamThe Netherlands

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