Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?

摘要

Objective: To determine the diagnostic accuracy of ultrasound guided fine needle aspiration (FNA) cytology and core needle biopsy (CNB)of axillary lymph nodes pre-operatively in newly diagnosed operable primary breast cancer.Methods: An observational study for all patients who underwent pre-operative FNA cytology or CNB during September 2013–August 2014was conducted at our institution (County Hospital, Stafford, UK). The accuracy of pre-operative axillary staging was compared to the postoperativehistology. For this sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated.Results: A total of 81 consecutive patients were evaluated by axillary ultrasound. Patients identified with potentially abnormal axillarylymph nodes underwent definitive surgery. Seven patients had positive cytology/histology who did not undergo definitive surgery and wereexcluded (N = 74) from the study. CNB had a sensitivity of 100% versus 72% (p = 0.006) for FNA cytology. Both had 100% specificity andPPV. The NPV of CNB was 100% versus 72% for FNA cytology. Among 35% of patients that underwent FNA cytology required repeatprocedure versus 2.6% of patients who underwent CNB. 0/38 patients that had CNB required a second operation while 7/43 patients withnegative FNA cytology had positive lymph nodes identified at sentinel lymph node biopsy (SLNB) requiring surgical re-intervention withaxillary node clearance.Conclusion: CNB was superior to FNA cytology when interrogating the axilla. We recommend CNB to be adopted routinely in pre-operativeaxillary staging to reduce surgical re-intervention.