Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer

Background: Axillary lymph node dissection is still performed as a staging procedure since lymph node status is the most important prognostic factor i n patients with breast cancer. Sentinel node biopsy may replace routine axi llary lymphadenectomy, especially in patients with small breast cancers. Th is study investigated whether ultrasonographically guided fine-needle aspir ation cytology (FNAC) of the axillary lymph nodes in clinically node-negati ve patients was an accurate staging procedure to select patients for sentin el node biopsy. Methods: One hundred and eighty-five consecutive patients were included. Al l had axillary ultrasonography and detected nodes were categorized accordin g to their dimensions and echo patterns. Ultrasonographically guided FNAC w as carried out if technically possible. These results were compared with th e results of the sentinel node biopsy and subsequent axillary dissection. Results: In 116 patients no lymph nodes were detected by ultrasonographic i maging. Of 69 patients with visible nodes, 31 had malignant cells on FNAC. There were no false-positive results. Some 87 of 185 patients had axillary metastases on definitive histological examination. Ultrasonography was sens itive in patients with extensive nodal involvement. Failure of the examinat ion was caused by problems learning the method, difficulty in puncturing sm all lymph nodes and sampling error. Conclusion: In patients without palpable axillary nodes, a sentinel node bi opsy could be avoided in 17 per cent since ultrasonography combined with FN AC had already diagnosed axillary metastases. The method is particularly va luable in larger breast cancers.