การศึกษาความแม่นยำของการตรวจคลื่นเสียงความถี่สูงร่วมกับการใช้เข็มเล็กเจาะดูดเพื่อตรวจทางเซลล์วิทยาของต่อมน้ำเหลืองที่รักแร้ในผู้ป่วยโรคมะเร็งเต้านมในโรงพยาบาลราชบุรี

Warunyupa Ouklib

Authors

Warunyupa Ouklib Department of Radiology, Ratchaburi hospital, Ratchaburi

Keywords:

CA breast, US-guided fine-needle aspiration, FNA, axillary staging

Abstract

Axillary staging in breast cancer patients was crucial for determining cancer staging and guiding treatment planning. The standard method for evaluating lymph node metastasis was through histopathological examination following surgical removal. However, ultrasound (US) combined with fine-needle aspiration cytology (FNAC) emerged as an alternative diagnostic approach for detecting axillary lymph node metastasis in breast cancer patients. This study had objective to evaluate the sensitivity, specificity and accuracy of ultrasound combined with fine-needle aspiration cytology (FNAC) in assessing axillary lymph node metastasis, compared with histopathological findings. This retrospective descriptive study used secondary data from medical record of breast cancer patients at Ratchaburi hospital between January 1^st, 2020, and July 30^th, 2024 who underwent ultrasound-guided fine-needle aspiration cytology (FNAC) for axillary lymph node evaluation. The results were compared with histopathological findings using descriptive statistical methods.

Results: Among 98 cases of complete data, the study revealed a sensitivity of 83.56%, specificity of 100%, a positive predictive value (PPV) of 100%, a negative predictive value (NPV) of 67.57%, and an overall accuracy of 87.76%.

Conclusion: Ultrasound combined with fine-needle aspiration cytology is a straightforward, time-efficient and highly accurate method for evaluating axillary lymph node metastasis in breast cancer patients. Due to its high sensitivity and specificity, this technique plays a crucial role in surgical planning by minimizing unnecessary procedures.

References

Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast. 2022;66:15-23.

Trapani D, Ginsburg O, Fadelu T, Lin NU, Hassett M, Ilbawi AM, et al. Global challenges and policy solutions in breast cancer control. Cancer Treat Rev. 2022;104:102339.

Lakha F, Suriyawongpaisul P, Sangrajrang S, Leerapan B, Coker R. Breast cancer in Thailand: policy and health system challenges to universal healthcare. Health Policy Plan. 2020;35(9):1159-67.

Solon JG, Power C, Al-Azawi D, Duke D, Hill AD. Ultrasound-guided core biopsy: an effective method of detecting axillary nodal metastases. J Am Coll Surg. 2012;214(1):12-7.

Ahlgren J, Stål O, Westman G, Arnesson LG. Prediction of axillary lymph node metastases in a screened breast cancer population. South-East Sweden Breast Cancer Group. Acta Oncol. 1994;33(6):603-8.

Banerjee M, George J, Song EY, Roy A, Hryniuk W. Tree-based model for breast cancer prognostication. J Clin Oncol. 2004;22(13):2567-75.

Shaw JH, Rumball EM. Complications and local recurrence following lymphadenectomy. Br J Surg. 1990;77(7):760-4.

Rafn BS, Christensen J, Larsen A, Bloomquist K. Prospective Surveillance for Breast Cancer-Related Arm Lymphedema: A Systematic Review and Meta-Analysis. J Clin Oncol. 2022;40(9):1009-26.

Giammarile F, Vidal-Sicart S, Paez D, Pellet O, Enrique EL, Mikhail-Lette M, et al. Sentinel Lymph Node Methods in Breast Cancer. Semin Nucl Med. 2022;52(5):551-60.

Montgomery LL, Thorne AC, Van Zee KJ, Fey J, Heerdt AS, Gemignani M, et al. Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer. Anesth Analg. 2002;95(2):385-8, table of contents.

Krishnamurthy S, Sneige N, Bedi DG, Edieken BS, Fornage BD, Kuerer HM, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer. 2002;95(5):982-8.

Popli MB, Sahoo M, Mehrotra N, Choudhury M, Kumar A, Pathania OP, et al. Preoperative ultrasound-guided fine-needle aspiration cytology for axillary staging in breast carcinoma. Australas Radiol. 2006;50(2):122-6.

van Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol. 2006;13(1):31-5.

Diaz-Ruiz MJ, Arnau A, Montesinos J, Miguel A, Culell P, Solernou L, et al. Diagnostic Accuracy and Impact on Management of Ultrasonography-Guided Fine-Needle Aspiration to Detect Axillary Metastasis in Breast Cancer Patients: A Prospective Study. Breast Care (Basel). 2016;11(1):34-9.