Meta‐analysis of the diagnostic accuracy of ultrasound‐guided fine‐needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis. BJS 2018; 105: 1244-1253.

Published: 4th July 2018

Authors: I. Balasubramanian, C. A. Fleming, M. A. Corrigan, H. P. Redmond, M. J. Kerin, A. J. Lowery et al.

Background

Axillary lymph node status remains a significant prognostic indicator in breast cancer. Here, the diagnostic accuracy of ultrasound‐guided fine‐needle aspiration (US‐FNA) and ultrasound‐guided core needle biopsy (US‐CNB) in axillary staging was compared.

Method

A comprehensive search was undertaken of all published studies comparing the diagnostic accuracy of US‐CNB and US‐FNA of axillary lymph nodes in breast cancer. Studies were included if raw data were available on the diagnostic performance of both US‐FNA and US‐CNB, and compared with final histology results. Relevant data were extracted from each study for systematic review. Meta‐analysis was performed using a random‐effects model. The pooled sensitivity and specificity of US‐FNA and US‐CNB were obtained using a bivariable model. Summary receiver operating characteristic (ROC) graphs were created to confirm diagnostic accuracy.

Results

Data on a total of 1353 patients from six studies met the inclusion criteria and were included in the final analysis. US‐CNB was superior to US‐FNA in diagnosing axillary nodal metastases: sensitivity 88 (95 per cent c.i. 84 to 91) versus 74 (70 to 78) per cent respectively. Both US‐CNB and US‐FNA had a high specificity of 100 per cent. Reported complication rates were significantly higher for US‐CNB compared with US‐FNA (7·1 versus 1·3 per cent; P < 0·001). Conversely, the requirement for repeat diagnostic procedures was significantly greater for US‐FNA (4·0 versus 0·5 per cent; P < 0·001).

Conclusion

US‐CNB is a superior diagnostic technique to US‐FNA for axillary staging in breast cancer.

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