Metastatic Axillary Lymphadenopathy in Breast Cancer: Diagnostic accuracy of Ultrasound Combined with Ultrasound Guided Fine Needle Aspiration

Objective: To detect sonographic criteria for detection of metastatic involvement of axillary lymph nodes (ALN) and to detect accuracy of ultrasound combined with ultrasound guided FNAC in staging workup of breast cancer. Methodology: A prospective cross-sectional study was conducted in the Radiology Department of the Sindh Institute of Urology and Transplantation (SIUT), Karachi, from October 2020 to October 2021. The study included patients diagnosed with either symptomatic or screen-detected breast cancer who underwent preoperative ultrasound evaluation of the breast and axilla. Fine-needle aspiration biopsy (FNAB) was performed on axillary lymph nodes with sonographic features suggestive of malignancy using an 18-gauge needle attached to a 10 mL disposable syringe. The aspirated samples were reviewed by a histopathologist. The diagnostic performance of ultrasound and ultrasound-guided FNAC was compared to the final histopathological findings of surgically excised axillary lymph nodes. Data were analyzed using SPSS version 20. Results: The mean age of the study participants was 48.05 ± 11.3 years. Ultrasound alone demonstrated a sensitivity of 60.9%, specificity of 39.5%, and overall accuracy of 79%. When combined with FNAC, diagnostic sensitivity increased to 92%, specificity to 85%, and accuracy to 53.1%. Notably, the highest diagnostic accuracy was observed with the combined use of ultrasound and FNAC, yielding a sensitivity of 81.8%, specificity of 62.0%, and overall accuracy of 74.6%. The combined approach also achieved the highest positive predictive value (78.9%) and negative predictive value (66.1%), indicating superior diagnostic performance. Conclusion: The combined use of ultrasound and ultrasound-guided FNAC proves to be a highly effective and reliable diagnostic modality for detecting metastatic axillary lymphadenopathy in breast cancer patients. This dual approach enhances diagnostic accuracy and supports its integration into the preoperative staging protocol for breast carcinoma.