Metastatic axillary lymphadenopathy in Breast cancer: Diagnostic accuracy of Ultrasound combined with Ultrasound guided fine needle aspiration (FNAC)

Abstract

Objective: To detect sonographic criteria for detection of metastatic involvement of axillary lymph nodes (ALN) and to detect accuracy of ultrasound and ultrasound guided FNAC in staging workup of breast cancer.
METHODS: A prospective cross-sectional study was done at Radiology department of SIUT from October 2020 to October 2021. Patients with both symptomatic and screen detected breast
cancer who underwent pre surgical ultrasound examination of breast and axilla were included. Breast and axillary ultrasound examinations were performed using a 14 MHz linear array transducer, and ultrasound-guided FNAC of abnormal axillary lymph nodes was conducted with an 18-gauge needle attached to a 10 mL disposable syringe, with the obtained lymph node specimens subsequently reviewed by a histopathologist. Ultrasound and ultrasound guided FNAC results were compared to the final histopathological results of surgically removed axillary lymph nodes in SLNB and ALND. The data was entered into and analysed by SPSS version 20.
Results: Overall mean age of the patients was 48.05+11.3 years. Ultrasound showed 84% sensitivity, 70% specificity and 79% accuracy, while combined with FNAC, the sensitivity found increased as 92%, specificity 85%, and 90% accuracy. Though, the highest diagnostic accuracy was achieved with the combination of US and FNAC, which showed a sensitivity of 97%,
specificity of 92%, and accuracy of 95%. The combined technique also had the highest positive predictive value (96%) and negative predictive value (93%), demonstrating superior diagnostic performance.
Conclusion: Study revealed that the combined use of ultrasound and ultrasound-guided fine-needle aspiration cytology observed to be a highly effective and reliable diagnostic tool with excellent diagnostic accuracy in the diagnosis of metastatic axillary lymphadenopathy in patients with breast carcinoma with 97% sensitivity, 92% specificity 95% overall accuracy.
Key words: Breast cancer, ALN, Ultrasound, FNAC, Sensitivity, Specificity