Objective: Axillary lymph node (LN) sampling is important for breast cancer staging and can be performed using fine needle aspiration (FNA). The aim of this study is to review the axillary LN FNAs performed at our institution prior to treatment, and to correlate their results with the available LN histology in order to evaluate the diagnostic utility of FNA. Study Design: A total of 130 cases were retrospectively identified over a 1-year period and reviewed. The FNA findings were correlated with the histological findings in 65 (50%) LN core biopsies, 43 (33%) sentinel LN biopsies, and 22 (17%) axillary dissections. Results: One hundred and thirteen FNA cases (89%) correlated with the histology, while 14 cases (11%) did not correlate, including 1 false positive and 13 false negatives. Of the false-negative cases, metastases in the biopsy ranged from isolated tumor cells to 5 mm in the greatest dimension. The overall sensitivity was 85%, specificity 98%, positive predictive value 99%, and negative predictive value 75%. Conclusion: Pretherapy staging of breast cancer by FNA is a useful diagnostic modality with a high specificity and positive predictive value. Due to false-negative diagnoses, a negative FNA should be followed up with further LN sampling.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ: Cancer statistics, 2009. CA Cancer J Clin 2009;59:225–249.
Burak WE, Hollenbeck ST, Zervos EE, Hock KL, Kemp LC, Young DC: Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer. Am J Surg 2002;183:23–27.
Mainiero MB: Regional lymph node staging in breast cancer: the increasing role of imaging and ultrasound-guided axillary lymph node fine needle aspiration. Radiol Clin North Am 2010;48:989–997.
Nassar A: Core needle biopsy versus fine needle aspiration biopsy in breast – a historical perspective and opportunities in the modern era. Diagn Cytopathol 2011;39:380–388.
Nizzoli R, Bozzetti C, Naldi N, et al: Comparison of the results of immunocytochemical assays for biologic variables on preoperative fine-needle aspirates and on surgical specimens of primary breast carcinomas. Cancer 2000;90:61–66.
Löfgren L, Skoog L, von Schoultz E, et al: Hormone receptor status in breast cancer – a comparison between surgical specimens and fine needle aspiration biopsies. Cytopathology 2003;14:136–142.
Moriki T, Takahashi T, Ueta S, Mitani M, Ichien M: Hormone receptor status and HER2/neu overexpression determined by automated immunostainer on routinely fixed cytologic specimens from breast carcinoma: correlation with histologic sections determinations and diagnostic pitfalls. Diagn Cytopathol 2004;30:251–256.
Sneige N: Utility of cytologic specimens in the evaluation of prognostic and predictive factors of breast cancer: current issues and future directions. Diagn Cytopathol 2004;30:158–165.
Sumiyoshi K, Shibayama Y, Akashi S, et al: Detection of human epidermal growth factor receptor 2 protein and gene in fine needle aspiration cytology specimens and tissue sections from invasive breast cancer: can cytology specimens take the place of tissue sections? Oncol Rep 2006;15:803–808.
Vargas HI, Masood S: Implementation of a minimally invasive breast biopsy program in countries with limited resources. Breast J 2003;9:S81–S85.
Kocjan G, Bourgain C, Fassina A, et al: The role of breast FNAC in diagnosis and clinical management: a survey of current practice. Cytopathology 2008;19:271–278.
Wallis M, Tarvidon A, Helbich T, Schreer I: Guidelines from the european society of breast imaging for diagnostic interventional breast procedures. Eur Radiol 2007;17:581–588.
Gilissen F, Oostenbroek R, Storm R, Westenend P, Plaisier P: Prevention of futile sentinel node procedures in breast cancer: ultrasonography of the axilla and fine-needle aspiration cytology are obligatory. Eur J Surg Oncol 2008;34:497–500.
Alkuwari E, Auger M: Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic-histologic correlation. Cancer Cytopathol 2008;114:89–93.
Alvarez S, Añorbe E, Alcorta P, López F, Alonso I, Cortés J: Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 2006;186:1342–1348.
Jain A, Haisfield-Wolfe ME, Lange J, et al: The role of ultrasound-guided fine-needle aspiration of axillary nodes in the staging of breast cancer. Ann Surg Oncol 2008;15:462–471.
Ciatto S, Brancato B, Risso G, et al: Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging. Breast Cancer Res Treat 2007;103:85–91.
Krishnamurthy S: Current applications and future prospects of fine-needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer. Cancer 2009;117:451–462.
Van Rijk MC, Deurloo EE, Nieweg OE, et al: Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol 2006;13:31–35.
Rao R, Lilley L, Andrews V, Radford L, Ulissey M: Axillary staging by percutaneous biopsy: sensitivity of fine-needle aspiration versus core needle biopsy. Ann Surg Oncol 2009;16:1170–1175.
Abe H, Schmidt RA, Kulkarni K, et al: Lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy-clinical experience in 100 patients. Radiology 2009;250:41–49.
Britton PD, Coud A, Godward S, et al: Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer. Eur Radiol 2009;19:561–569.
He Q, Fan X, Yuan T, et al: Eleven years of experience reveals that fine-needle aspiration cytology is still a useful method for preoperative diagnosis of breast cancer. Breast 2007;16:303–306.
Philpotts LE, Hooley RJ, Lee CH: Comparison of automated versus vacuum-assisted biopsy methods for sonographically guided core biopsy of the breast. AJR Am J Roentgenol 2003;180:347–351.
Simon JR, Kalbhen CL, Cooper RA: Accuracy and complications rates of US-guided vacuum-assisted core breast biopsy: initial results. Radiology 2000;205:694–697.
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