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

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Abstract

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.

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Authors and Affiliations

  1. Department of Surgery, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands

    G. M. Kramer, M. W. H. Leenders & W. H. Schreurs

  2. Department of Radiology, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands

    L. J. Schijf & H. L. S. Go

  3. Department of Statistics, Noordwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands

    T. van der Ploeg

  4. Department of Surgery, VU Medical Centre, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands

    M. P. van den Tol

Authors
  1. G. M. Kramer
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  2. M. W. H. Leenders
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  3. L. J. Schijf
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  4. H. L. S. Go
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  5. T. van der Ploeg
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  6. M. P. van den Tol
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  7. W. H. Schreurs
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Corresponding author

Correspondence to G. M. Kramer.

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The authors declare that they have no conflict.

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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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Kramer, G.M., Leenders, M.W.H., Schijf, L.J. et al. Is ultrasound-guided fine-needle aspiration cytology of adequate value in detecting breast cancer patients with three or more positive axillary lymph nodes?. Breast Cancer Res Treat 156, 271–278 (2016). https://doi.org/10.1007/s10549-016-3755-6

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  • DOI: https://doi.org/10.1007/s10549-016-3755-6

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