Objective: This study evaluates the diagnostic accuracy of axillary lymph node fine needle aspiration (FNA) cytology in breast cancer and correlates it with clinical parameters/outcomes. Study Design: A total of 91 females underwent FNA of axillary lymph nodes at our institution from January 2007 to February 2013. The cases were classified as ‘positive', ‘negative for malignancy' and ‘nondiagnostic'. Results: Forty-six cases (50.5%) had a histologic follow-up (4.4 ± 3.1 months); of these, 22 (47.8%) were true positive, 7 (15.2%) were true negative, 2 (4.3%) were false negative, 5 (11%) were false positive and 10 (21.7%) were nondiagnostic. However, cytological review of all false positive and false negative cases confirmed the presence or absence of tumor, respectively. All false positive cases had undergone preoperative neoadjuvant chemotherapy, with no residual tumor present, and a treatment effect identified only histologically. Meanwhile, the 2 false negative cases involved micrometastasis (≤1.5 mm). Thus, if we exclude these false positive cases (complete responders), then the sensitivity, specificity, positive predictive value and negative predictive value were 91.7, 100, 100 and 77.8%, respectively. All preoperative FNA-positive axillary lymph nodes were spared from sentinel lymph node biopsy except for 3 of 27 (11.1%). Conclusion: We suggest that axillary lymph node FNA is a highly sensitive technique with a low false negative rate (4.3%) and a diagnostic accuracy of 93.5%.

1.
Fitzgibbons PL, Page DL, Weaver D, Thor AD, Allred DC, Clark GM, Ruby SG, O'Malley F, Simpson JF, Connolly JL, Hayes DF, Edge SB, Lichter A, Schnitt SJ: Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000;124:966-978.
2.
Chang MC, Crystal P, Colgan TJ: The evolving role of axillary lymph node fine-needle aspiration in the management of carcinoma of the breast. Cancer Cytopathol 2011;119:328-334.
3.
Turaga KK, Chau A, Eatrides JM, Kiluk JV, Khakpour N, Laronga C, Lee MC: Selective application of routine preoperative axillary ultrasonography reduces costs for invasive breast cancers. Oncologist 2011;16:942-948.
4.
Park SH, Kim MJ, Park BW, Moon HJ, Kwak JY, Kim EK: Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol 2011;18:738-744.
5.
Monaco SE, Colaizzi A, Kanbour A, Ibrahim AS, Kanbour-Shakir A: The role of axillary lymph node fine needle aspiration in breast cancer staging prior to chemotherapy with histological correlation. Acta Cytol 2012;56:139-145.
6.
Schiettecatte A, Bourgain C, Breucq C, Buls N, De Wilde V, de Mey J: Initial axillary staging of breast cancer using ultrasound-guided fine needle aspiration: a liquid-based cytology study. Cytopathology 2011;22:30-35.
7.
van Wely BJ, de Wilt JH, Schout PJ, Kooistra B, Wauters CA, Venderinck D, Strobbe LJ: Ultrasound-guided fine-needle aspiration of suspicious nodes in breast cancer patients; selecting patients with extensive nodal involvement. Breast Cancer Res Treat 2013;140:113-118.
8.
Kuenen-Boumeester V, Menke-Pluymers M, de Kanter AY, Obdeijn IM, Urich D, Van Der Kwast TH: Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure. Eur J Cancer 2003;39:170-174.
9.
Krishnamurthy S, Sneige N, Bedi DG, Edieken BS, Fornage BD, Kuerer HM, Singletary SE, Hunt KK: Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer 2002;95:982-988.
10.
Brown AS, Hunt KK, Shen J, Huo L, Babiera GV, Ross MI, Meric-Bernstam F, Feig BW, Kuerer HM, Boughey JC, Ching CD, Gilcrease MZ: Histologic changes associated with false-negative sentinel lymph nodes after preoperative chemotherapy in patients with confirmed lymph node-positive breast cancer before treatment. Cancer 2010;116:2878-2883.
11.
Erbes T, Orlowska-Volk M, Zur Hausen A, Rücker G, Mayer S, Voigt M, Farthmann J, Iborra S, Hirschfeld M, Meyer PT, Gitsch G, Stickeler E: Neoadjuvant chemotherapy in breast cancer significantly reduces number of yielded lymph nodes by axillary dissection. BMC Cancer 2014;14:4.
12.
MacNeill M, Arnott I, Thomas J: Fine needle aspiration cytology is a valuable adjunct to axillary ultrasound in the preoperative staging of breast cancer. J Clin Pathol 2011;64:42-46.
13.
Park SH, Kim EK, Park BW, Kim SI, Moon HJ, Kim MJ: False negative results in axillary lymph nodes by ultrasonography and ultrasonography-guided fine-needle aspiration in patients with invasive ductal carcinoma. Ultraschall Med 2013;34:559-567.
14.
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 2008;114:89-93.
15.
Fung AD, Collins JA, Campassi C, Ioffe OB, Staats PN: Performance characteristics of ultrasound-guided fine-needle aspiration of axillary lymph nodes for metastatic breast cancer employing rapid on-site evaluation of adequacy: analysis of 136 cases and review of the literature. Cancer Cytopathol 2014;122:282-291.
16.
Sahoo S, Sanders MA, Roland L, Pile N, Chagpar AB: A strategic approach to the evaluation of axillary lymph nodes in breast cancer patients: analysis of 168 patients at a single institution. Am J Surg 2007;194:524-526.
17.
Ciatto S, Brancato B, Risso G, Ambrogetti D, Bulgaresi P, Maddau C, Turco P, Houssami N: 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.
18.
O'Leary DP, O'Brien O, Relihan N, McCarthy J, Ryan M, Barry J, Kelly LM, Redmond HP: Rapid on-site evaluation of axillary fine-needle aspiration cytology in breast cancer. Br J Surg 2012;99:807-812.
19.
Jung J, Park H, Park J, Kim H: Accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology for axillary staging in breast cancer. ANZ J Surg 2010;80:271-275.
20.
Altomare V, Guerriero G, Carino R, Battista C, Primavera A, Altomare A, Vaccaro D, Esposito A, Ferri AM, Rabitti C: Axillary lymph node echo-guided fine-needle aspiration cytology enables breast cancer patients to avoid a sentinel lymph node biopsy. Preliminary experience and a review of the literature. Surg Today 2007;37:735-739.
21.
van Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ, Kröger R, Kroon BB: Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol 2006;13:31-35.
22.
Alvarado R, Yi M, Le-Petross H, Gilcrease M, Mittendorf EA, Bedrosian I, Hwang RF, Caudle AS, Babiera GV, Akins JS, Kuerer HM, Hunt KK: The role for sentinel lymph node dissection after neoadjuvant chemotherapy in patients who present with node-positive breast cancer. Ann Surg Oncol 2012;19:3177-3184.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.