In a meta-analysis of 1,353 patients from 6 studies, US-guided core needle biopsy was superior to US-guided FNA in diagnosing axillary nodal metastases with reported pooled sensitivity of 88% versus 74%, respectively. Both US-guided core needle biopsy and FNA had a high specificity of 100% [86]. Complications such as pain, hematoma, and bruising were higher with core needle biopsy than FNA. US-Guided Fine Needle Aspiration Biopsy Axillary Node US-guided FNA biopsy is a reliable procedure associated with minimal complications. In a meta-analysis of 31 studies, US-guided FNA improved the median sensitivity of US from 61% to 79% and specificity from 82.0% to 100% [62]. In another publication of 3,781 breast cancer patients, the sensitivity and specificity of axillary US alone were 59% and 89%, respectively. The specificity improved to 100% when axillary US was combined with FNA. FNA resulted in sensitivity, specificity, PPV, NPV, and accuracy of 52%, 100%, 100%, 74.8%, and 80%, respectively [63]. The decision to perform FNA or core biopsy of a suspicious axillary node is not standardized and depends on provider choice and patient factors. Variant 12: Female. Suspicious axillary node on any other imaging modality (excluding mammography and ultrasound). Next imaging study. Digital Breast Tomosynthesis Diagnostic When a suspicious lymph node is identified on imaging, correlation with clinical history and physical examination is essential to guide management. If a breast primary is of concern, mammography and DBT can assist in identifying the breast primary. At least one study has shown that DBT is superior to full-field digital mammography for detection of subtle architectural distortion [161]. Mammography Diagnostic When a suspicious lymph node is identified on imaging, other than mammography or DBT, correlation with clinical history and physical examination is essential to guide further imaging.
Imaging of the Axilla. In a meta-analysis of 1,353 patients from 6 studies, US-guided core needle biopsy was superior to US-guided FNA in diagnosing axillary nodal metastases with reported pooled sensitivity of 88% versus 74%, respectively. Both US-guided core needle biopsy and FNA had a high specificity of 100% [86]. Complications such as pain, hematoma, and bruising were higher with core needle biopsy than FNA. US-Guided Fine Needle Aspiration Biopsy Axillary Node US-guided FNA biopsy is a reliable procedure associated with minimal complications. In a meta-analysis of 31 studies, US-guided FNA improved the median sensitivity of US from 61% to 79% and specificity from 82.0% to 100% [62]. In another publication of 3,781 breast cancer patients, the sensitivity and specificity of axillary US alone were 59% and 89%, respectively. The specificity improved to 100% when axillary US was combined with FNA. FNA resulted in sensitivity, specificity, PPV, NPV, and accuracy of 52%, 100%, 100%, 74.8%, and 80%, respectively [63]. The decision to perform FNA or core biopsy of a suspicious axillary node is not standardized and depends on provider choice and patient factors. Variant 12: Female. Suspicious axillary node on any other imaging modality (excluding mammography and ultrasound). Next imaging study. Digital Breast Tomosynthesis Diagnostic When a suspicious lymph node is identified on imaging, correlation with clinical history and physical examination is essential to guide management. If a breast primary is of concern, mammography and DBT can assist in identifying the breast primary. At least one study has shown that DBT is superior to full-field digital mammography for detection of subtle architectural distortion [161]. Mammography Diagnostic When a suspicious lymph node is identified on imaging, other than mammography or DBT, correlation with clinical history and physical examination is essential to guide further imaging.