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KMID : 1114620170140010015
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Journal of the Korean Society for Breast Screening
2017 Volume.14 No. 1 p.15 ~ p.20
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Usefulness of Ultrasonography and Ultrasonography-guided Fine-Needle Aspiration Biopsy for Axillary Staging in Breast Cancer: Application of Breast Imaging Reporting and Data System (BI-RADS)
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Ahn Hye-Shin
Kim Sun-Mi
Jang Mi-Jung
Yun Bo-La
Lee Soo-Hyun
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Abstract
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Purpose: To evaluate the accuracy of ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) for diagnosing metastatic invasion of the axilla in breast carcinoma patients and to determine the applicability of the BI-RADS categorization.
Materials and Methods: We retrospectively reviewed data on 858 patients who underwent preoperative or prechemotherapy axillary US for axillary staging from January 2009 to December 2011. USguided FNAB was performed if lymph nodes showed any suspicious findings with regard to malignancy according to the BI-RADS categorization: even cortical thickening with preserved hilum, Category 4a (C4a); even cortical thickening with compressed hilum or uneven cortical
thickening with preserved hilum, C4b; uneven cortical thickening with compressed hilum, C4c; hypoechoic mass with loss of hilum, C5. US and FNAB findings were compared using sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) data.
Results: Of 858 patients, 212 (24.7%) showed suspicious nodes on US and underwent US-guided FNAB. Of these 212 patients, 91 (42.9%) showed positive findings, 112 (52.8%) showed negative findings, and 9 showed insufficient findings on FNAB. Of the 858 patients, 767 patients either with a normal axillary US (n = 646) or without positive findings on FNAB (n = 121) underwent SLNB. Of these patients, 169 (22%) had metastatic lymph nodes. Of the 91 patients with positive FNAB findings, 57 underwent neoadjuvant chemotherapy and 34 underwent ALND. The sensitivity, specificity, positive predictive value, and negative predictive value of US were 47.6%, 86%, 60.4%, and 79.7%, respectively and US-guided FNAB were 71.7%, 100%, 100%, and 70.2%, respectively. The positive predictive value of US was 26.3% in C4a, 67.4% in C4b, 46.4% in C4c, and 93.3% in C5.
Conclusion: Axillary US and US-guided FNAB showed high specificity. A categorization similar to BI-RADS could be applicable for assessing axillary lymph node involvement in breast cancer patients.
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KEYWORD
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Breast cancer, Axillary lymph node, Ultrasonography (US), Fine needle aspiration biopsy (FNAB)
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