Prevention of futile sentinel node procedures in breast cancer: Ultrasonography of the axilla and fine-needle aspiration cytology are obligatory

Aims: To determine the value of ultrasonography (US) and fine-needle aspiration (FNA) of the axilla in preventing futile sentinel node procedures (SNP) in breast cancer. Methods: Between July 2004 and June 2005, 209 female patients were evaluated and treated in our clinic for histologically proven breast carcinoma. We analysed the results of axillary staging by US and FNA retrospectively. Furthermore, we correlated the histopathologic outcome of operative procedures with the preoperative findings during examination of the axilla. Results: Of the 209 patients, 195 underwent US of the axilla. In 67 patients, US was followed by FNA because of suspect lymph nodes in the axilla. Ninety-three of these 195 patients had axillary metastases. In 52 of these 93 patients, the metastases were detected prior to surgery, so that these 52 patients could be scheduled immediately for axillary lymph node dissection (ALND) and a futile SNP could be prevented. US/FNA yielded false-negative results in 41 cases, 13 of which had only a micrometastasis. Conclusions: By preoperative US and FNA of the axilla in patients with breast cancer, half of the axillary metastases can be detected prior to surgery. In more than a quarter of breast cancer patients, a futile SNP can be prevented. Therefore, preoperative US of the axilla plus FNA are obligatory in patients with breast carcinoma. (c) 2007 Elsevier Ltd. All rights reserved.