Effectiveness of Ultrasound Guided Fine Needle Aspiration in Detecting Axillary Lymph Node Metastases in Early Breast Cancer at Kenyatta National Hospital.

Abstract

Background: Breast cancer is the second commonest malignancy among women in Kenya. Axillary nodal status is key to its management. Ultrasound guided FNA and sentinel lymph node biopsy (SLNB) can be used. In our set up axillary staging is mainly performed by clinical examination and histopathological results of axillary dissection. The latter has a high morbidity. There is paucity of studies locally involving US guided FNA in staging the axilla. This study aimed to compare the effectiveness of Ultrasound guided FNA cytology in axillary nodal status staging with axillary lymph node dissection. Objective: To determine effectiveness of ultrasound guided FNA in detecting axillary lymph node metastasis in early breast cancer at KNH Study Design: A Prospective Study. Setting: Kenyatta National Hospital, Nairobi Kenya Methodology: This was a 12 month prospective study done between March 2016 and March 2017. Seventy nine female surgical patients seen in surgical outpatient clinics and wards diagnosed with early breast cancer were participated. The bio data including age and sex of the patient, size of the primary tumour were taken. Axillary ultrasound for determination of the presence of lymph node, its characteristics was done. Axillary lymph node ultrasound guided FNA was done and specimen taken for cytology. Patients then underwent modified radical mastectomy with ALND. The histopathology results of the lymph node FNA was done. Modified radical mastectomy outcome was taken as the definitive diagnosis.

and ALND .Patients who didn’t have axillary FNA results were 19 while 6 patients were missing ALND results. Patients with negative FNA of axilla were 19 while a total of 13 patients had axilla FNA which was non diagnostic. Twenty five patients had positive lymph nodes on FNA . Data was entered in an Excel, cleaned then exported to SPSS version 23 for analysis. The FNA results of the axilla in 51 patients were compared with ALND. The sensitivity of u/s guided FNA was 90%.Only two patient who had non diagnostic results on FNA cytology returned positive results on ALND. The nondiagnostic (indeterminate) was treated as negative. The positive predictive value was high at 94.74%.The specificity was high at 96.88. % . The negative predictive value was high at 93.9%.The ultrasound results of axillary lymph node morphology was recorded. The average size of axillary lymph nodes was 2.5cm.The primary tumour average T2. Conclusion: Ultrasound guided FNA cytology of the axilla may be useful in predicting axillary lymph node metastasis and determining patients who may require ALND for the positive metastatic nodes or a less morbid procedure of sentinel lymph node biopsy for a negative axillary nodes.