The accuracy of USG and USG guided FNAC axilla in predicting nodal metastasis in a clinically lymph node negative cancer breast patient

Vaibhav Shrivastava, Sanjay Singh, Sanjay Singh, Aklesh Kumar Maurya, Aklesh Kumar Maurya, Mayurika Singh, Mayurika Singh, Sabin Sam, Sabin Sam, Surendra Kumar Gupta, Surendra Kumar Gupta


Background: Breast malignancies are the second most common cause of cancer-related mortality among women. As the size of the primary breast cancer increases, some cancer cells are shed into cellular spaces and transported via the lymphatic network of the breast to the regional lymph nodes, especially the axillary lymph nodes. Objective of the study was to determine the accuracy of USG and US-FNAC in detecting lymph node metastasis in a clinically lymph node negative CA Breast patient.

Methods: This prospective study was conducted on 40 consecutive patients with biopsy proven breast cancer with clinically negative axilla, who had attending the OPD or IPD in our department of surgery, Swaroop Rani Nehru Hospital, Allahabad, during the period of 2014 to 2015. All of these patients were planned to undergo surgery (breast conservation or modified radical mastectomy with axillary clearance).

Results: Sensitivity of the study = 97.77%, specificity = 25%, positive predictive value =92.01%, negative predictive value =50%, diagnostic accuracy =90%.

Conclusions: Using axillary ultrasound and selective US-FNAC is a rapid, non-morbid method of staging the axilla in newly diagnosed breast cancer patients and should become a routine part of patient care because it can spare many patients particularly those who are undergoing axillary dissection.


Axillary lymph node, CA Breast, US-FNAC

Full Text:



Jain SA, Agarwal L, Goyal A, Kumar R, Shravan, Ameta A, et al. “Study on Efficacy of Preoperative Ultrasonography for Axillary Lymph Node Involvement In Breast Carcinoma. IOSR-JDMS. 2014;4(2).

Feng Y, Huang R, He Y, Lu A, Fan Z, Fan T, et al. “Efficacy of physical examination, ultrasound, and ultrasound combined with fine-needle aspiration for axilla staging of primary breast cancer” Breast Cancer Research and Treatment. 2015;149(3):761-5.

Ahn HS, Kim SM, Jang M, La Yun B, Kim SW, Kang E, et al. Comparison of sonography with sonographically guided fine-needle aspiration biopsy and core-needle biopsy for initial axillary staging of breast cancer. J Ultrasound Med. 2013;32(12):2177-84.

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(2):89-93.

Holwitt DM, Swatske ME, Gillanders WE, Monsees BS, Gao F, Aft RL, et al. The combination of axillary ultrasound and ultrasound-guided biopsy is an accurate predictor of axillary stage in clinically node-negative breast cancer patients, Am J Surg. 2008;196(4):477-82.

Verbanck J, Vandewiele I, De Winter H, Tytgat J, Van Aelst F, Tanghe W. Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: a prospective study in 144 consecutive patients, J Clin Ultrasound. 1997;25(2):53-6.

Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD, et al. Cortical Morphologic Features of Axillary Lymph Nodes as a Predictor of Metastasis in Breast Cancer: In Vitro Sonographic Study. A J R. 2008;191:646-52.

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(2):170-4.