Ultrasound guided needle biopsy of axilla to evaluate nodal metastasis after preoperative systemic therapy of 106 breast cancer cases

Aim of the study is to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after preoperative systemic therapy (PST). From January 2016 – October 2020 106 node positive stage IIA-IIIC breast cancer cases undergoing PST were included in the study.  After PST restaging of axilla was performed with ultrasound and FNAC of the marked and/or the most suspicious axillary node. In 72/106 cases axilla conserving surgery and in 34/106 cases axillary lymph node dissection (ALND) was performed.In order to assess diagnostic value of ultrasound guided FNAC, FNR and FPR as well sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated. Statistical analyses were performed using Medcalc, easy-to-use software and MS Excel 2010. Fisher’s exact test was used for comparison of the results between groups. False Positive Rate (FPR) of FNAC after PST is 8% and False Negative Rate (FNR) – 43%. Overall Sensitivity - 55%, specificity- 93%, accuracy 70%. FNAC after PST has low FPR and is useful to predict residual axillary disease and to streamline surgical decision making regarding ALND. FNR is high and FNAC alone are not able to predict ypCR and omission of further axillary surgery. However, FNAC performance in BRCA1/2 positive subgroup is more promising and further research with larger number of cases is necessary to confirm the results.