COMMENTARY

Ultrasound-Guided Core-Needle Biopsy Superior for Axillary Staging in Breast Cancer

Albert B. Lowenfels, MD

Disclosures

November 09, 2018

In women with breast cancer, what is the best strategy to ascertain the status of axillary lymph nodes? To answer this question, the authors of a paper published in the British Journal of Surgery performed a meta-analysis comparing ultrasound-guided fine-needle aspiration (US-FNA) with ultrasound-guided core-needle biopsy (US-CNB).[1]

From a total of 142 studies, six studies remained after reviewing published documents. All six had some evidence of bias, including a lack of initial randomization. The "gold standard" for determining true nodal status was sentinel node biopsy or axillary lymph node dissection.

US-CNB proved superior to US-FNA with respect to sensitivity, which was 88% (95% confidence interval [CI], 84%-91%) compared with 74% (95% CI, 70%-78%) for US-FNA. Complication rates were higher for US-CNB (7.1%) than for US-FNA (1.3%; P < .001), but the need for repeat biopsy was higher for US-FNA (4.0% vs 0.5% for US-CNB; P < .001). For both procedures, the specificity was 100%.

The Take-Home Message

There is continued need to assess the axillary status of patients with breast cancer because it is crucial for further therapeutic decisions. Although both procedures performed reasonably well, US-CNB was the preferred choice, mainly because of the reduced number of patients who needed a repeat biopsy.

It is hard to evaluate the significance of postoperative complications, because in three of the six included studies US-FNA was followed by US-CNB, making it difficult to determine which of the two procedures was responsible for the postoperative complication.

The take-home message from this meta-analysis is that although both US-FNA and US-CNB perform reasonably well, US-CNB supplies more tissue for analysis, and is the preferred choice.

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