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CC BY 4.0 · Brazilian Journal of Oncology 2021; 17: e-20200044
DOI: 10.5935/2526-8732.20200044
Original Article
Clinical Oncology

Accuracy of ultrasound-guided fine needle aspiration cytology (US-FNAC) to detect axillary involvement in breast cancer

Acurácia da citologia de punção aspirativa por agulha fina (PAAF) guiada por ultrassonografia na detecção do comprometimento axilar pelo câncer de mama

Maria Carolina Gouveia 
1   Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Breast surgery - Recife - Pernambuco - Brazil
,
Candice Lima Santos 
2   Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Oncology - Recife - Pernambuco - Brazil
,
Isabel Cristina Pereira 
1   Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Breast surgery - Recife - Pernambuco - Brazil
,
Ariani Impieri Souza 
3   Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Gynecology - Recife - Pernambuco - Brazil
› Institutsangaben Financial support: none to declare.
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ABSTRACT

Introduction: Axillary involvement is one of the main prognostic factors in breast cancer. This study aimed to assess the accuracy of ultrasound-guided fine needle aspiration cytology (US-FNAC) to detect axillary involvement in breast cancer and to compare with other methods of axilla assessment: axillary palpation (AP) and isolated axillary ultrasound (A-US). Methods: A retrospective accuracy study was performed using data from medical records of patients assisted at a breast cancer service in Recife, Brazil, between 2013 and 2017. A histopathological result (sentinel lymph node and/or axillary dissection) was adopted as a gold standard. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the AP, the A-US and US-FNAC were calculated. Results: 206 tumors were analyzed. The AP was truly positive in 34.0% of the results similar values were obtained for A-US (36.4%). The lowest incidence of false negative was in the US-FNAC (16.5%). Axillary involvement was identified in 82 (39.8%) cases. The US-FNAC was performed in 79 cases, 51 (64.5%) were identified as true positive and 13 (16.5%) were false negative. When analyzing the comparative results of AP, A-US and the US-FNAC of the axilla with histopathology, it was observed that AP presented an accuracy of 69.9% (95%CI=63.1-76.1), better than the A-US, which its accuracy was 68% (95%CI=61.1-74.3). The US-FNAC showed high specificity (100%, 95%CI=81.9-100%), of PPV at 100% (95%CI=94.3-100%), but with a low NPV (53.6%, 95%CI=33.9-72.5). The best NPV was the AP (59.7%, 95%CI=50.5-68.4). The US-FNAC accuracy was 83.5% (95%CI=73.591.0). Conclusion: The good accuracy associated to the high specificity and the PPV of the US-FNAC suggests it to be a promising examination in the diagnosis of axillary involvement in breast cancer and an ally to better define therapeutic conducts.

RESUMO

Introdução: O envolvimento axilar é um dos principais fatores prognósticos no câncer de mama. Este estudo teve como objetivo avaliar a acurácia da citologia aspirativa por agulha fina guiada por ultrassom (AAF-US) para detectar envolvimento axilar no câncer de mama e comparar com outros métodos de avaliação da axila: palpação axilar (PA) e ultrassom axilar isolado (US-A). Métodos: Foi realizado um estudo retrospectivo de acurácia com dados de prontuários de pacientes atendidas em um serviço de câncer de mama no Recife, Brasil, entre 2013 e 2017. O resultado histopatológico (linfonodo sentinela e/ou dissecção axilar) foi adotado como padrão ouro. Sensibilidade, especificidade, acurácia, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) do AP, o US-A e o AAF-US foram calculados. Resultados: Foram analisados 206 tumores. O PA foi verdadeiramente positivo em 34,0% dos resultados, valores semelhantes foram obtidos para US-A (36,4%). A menor incidência de falso negativo foi no AAFUS (16,5%). Envolvimento axilar foi identificado em 82 (39,8%) casos. O AAF-US foi realizado em 79 casos, 51 (64,5%) foram identificados como verdadeiro positivo e 13 (16,5%) falso negativo. Ao analisar os resultados comparativos do PA, US-A e o AAF-US da axila com a histopatologia, observou-se que o PA apresentou uma acurácia de 69,9% (IC95%=63,1-76,1), melhor que o US-A, cuja acurácia foi de 68% (IC95%=61,1-74,3). O AAF-US mostrou alta especificidade (100%, IC95%=81,9-100%), com VPP em 100% (IC95%=94,3-100%), mas com um baixo VPN (53,6%, IC95%=33,9-72,5). O melhor VPN foi o PA (59,7%, IC95%=50,5-68,4). A acurácia do AAF-US foi de 83,5% (IC95%=73,5-91,0). Conclusão: A boa acurácia associada à alta especificidade e ao VPP do AAF-US sugere que este seja um exame promissor no diagnóstico de acometimento axilar no câncer de mama e um aliado para definir melhores condutas terapêuticas.

Keywords:

Neoplasias mamárias - Biópsia com agulha fina - Terapia neoadjuvante - Linfonodo sentinela.

Descritores:

Neoplasias mamárias - Biópsia com agulha fina - Terapia neoadjuvante - Linfonodo sentinela.

Funding details

There was no funding support.


Ethical approval

This research was approved by the Research Ethics Committee at IMIP (CAAE number: 81475317.5.0000.5201).


Disclosure statement

All the authors declared no conflicts of interests.




Publikationsverlauf

Eingereicht: 02. Juli 2020

Angenommen: 06. November 2020

Artikel online veröffentlicht:
18. Januar 2021

© 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Bibliographical Record
Maria Carolina Gouveia, Candice Lima Santos, Isabel Cristina Pereira, Ariani Impieri Souza. Accuracy of ultrasound-guided fine needle aspiration cytology (US-FNAC) to detect axillary involvement in breast cancer. Brazilian Journal of Oncology 2021; 17: e-20200044.
DOI: 10.5935/2526-8732.20200044
 

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