Predicting Nodal Burden in Clinically N0 Breast Cancer: A Comparison Between Ultrasound-Guided Fine Needle Aspiration Cytology (FNAC) and Sentinel Lymph Node Biopsy (SLNB)

  • Gaurav Goel
  • P. D. Janaki
  • R. Anupama
  • Reshu Agarwal
  • D. K. Vijaykumar
Original Article



Post-Z0011 era there is much debate on omitting axillary clearance in select group of patients. However, there is difference in nodal burden in SLNB and FNAC positive group even though both are clinically N0. This study compares the nodal burden in SLNB and FNAC positive patients of clinically N0 breast cancer.


Retrospective data collection was done for a period between June 2014 and May 2016 from institutional-based cancer registry for clinically N0 breast cancer patients. A total of 72 patients with SLNB and image-guided FNAC positive node and who underwent complete ALND were found to be eligible for the present study.


Out of 72 patients, who underwent complete ALND, 45 were US-FNAC positive and 27 were SLNB positive. Ultrasound-guided FNAC positive patients had higher nodal burden N2 (31.1 vs. 7.4%) and N3 (22.22% vs. 0) compared with SLNB positive patients. Ultrasound-guided FNAC positive patients had higher hormone receptor negative and Her2/neu positive tumor with high Ki 67 (>20%) compared with SLNB positive group. Mean positive lymph nodes in FNAC group were 5.16 ± 4.781 compared to 1.67 ± 1.074 in SLNB positive groups. Among 27 SLNB positive patients, sentinel lymph node was the only positive node in 20 patients and 5 had just one additional positive node.


Ultrasound FNAC positivity predicts higher nodal burden in clinically N0 patients compared with SLNB positive patients. Further studies are needed to support above findings and to define patients in FNAC positive group which can be exempted from complete ALND.


Axillary ultrasound Nodal burden Sentinel lymph node biopsy Breast cancer 



I would like to acknowledge the support of Mr. Unnikrishnan UG who helped me with the statistical analysis.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Association of Gynecologic Oncologists of India 2017

Authors and Affiliations

  • Gaurav Goel
    • 1
  • P. D. Janaki
    • 2
  • R. Anupama
    • 3
  • Reshu Agarwal
    • 3
  • D. K. Vijaykumar
    • 3
  1. 1.DNB Surgical Oncology Resident, Department of Surgical Oncology, Amrita Institute of Medical SciencesAmrita VishwavidyapeethamCoimbatoreIndia
  2. 2.Department of Radiology, Amrita Institute of Medical SciencesAmrita VishwavidyapeethamCoimbatoreIndia
  3. 3.Department of Breast and Gynecological Oncology, Amrita Institute of Medical SciencesAmrita VishwavidyapeethamCoimbatoreIndia

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