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Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer.

Authors
 So Hee Park  ;  Min Jung Kim  ;  Byoung-Woo Park  ;  Hee Jung Moon  ;  Jin Young Kwak  ;  Eun-Kyung Kim 
Citation
 Annals of Surgical Oncology, Vol.18(3) : 738-744, 2011 
Journal Title
 Annals of Surgical Oncology 
ISSN
 1068-9265 
Issue Date
2011
Abstract
PURPOSE: To evaluate the accuracy of preoperative ultrasonography (US) and US-guided fine-needle aspiration (US-FNA) for detecting axillary lymph node (ALN) metastasis. PATIENTS AND METHODS: We retrospectively reviewed 382 breast cancer patients with clinically negative ALN who underwent US and/or US-FNA for ALN. US-FNA of ALN was performed in 121 patients with suspicious findings on US. The diagnostic performance of US alone or with the addition of US-FNA for detecting ALN metastasis was calculated on the basis of final pathologic reports of ALN surgery. RESULTS: Among a total of 382 patients, 129 had metastatic ALNs while 253 exhibited no signs of axillary metastasis on final pathology. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of axillary US alone were 56.6% (73/129), 81.0% (205/253), 60.3% (73/121), and 78.5% (205/261), respectively. Addition of US-FNA resulted in sensitivity, specificity, PPV, and NPV of 39.5% (51/129), 95.7% (242/253), 82.3% (51/62), and 75.6% (242/320), respectively. Excluding complete responders to neoadjuvant chemotherapy, specificity and PPV after adding US-FNA were increased to 99.6% (242/243) and 98.1% (51/52), respectively. The sensitivity and specificity of ALN metastasis were similar between the palpable and nonpalpable breast cancer groups; however, after adding US-FNA, NPV was increased in the nonpalpable breast cancer group compared with the palpable breast cancer group (p = 0.0398). By including preoperative axillary US and US-FNA, 16.2% (62/382) of all breast cancer patients were able to avoid unnecessary sentinel lymph node biopsy (SLNB). CONCLUSIONS: The combination of axillary US and US-FNA is useful in preoperative work-up of breast cancer patients and provides valuable information for planning proper breast cancer management.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/92640
DOI
10.1245/s10434-010-1347-y
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
Yonsei Authors
곽진영(Kwak, Jin Young) ; 김민정(Kim, Min Jung) ; 김은경(Kim, Eun-Kyung) ; 문희정(Moon, Hee Jung) ; 박병우(Park, Byeong Woo) ; 박소희(Park, So Hee)
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Full Text
http://link.springer.com/article/10.1245%2Fs10434-010-1347-y
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