Correlation between the intrinsic subtype and diagnostic methodsof axillary lymph node metastasis in primary breast cancer

Objectives: To discover the relationship between intrinsic subtypes and axillary lymph nodes metastatic proportion, to compare the accuracy of clinical examination, ultrasound-guided fine-needle aspiration cytology of suspicious axillary nodes, and to evaluate the best method of axillary lymph nodes staging in patients with breast cancer. Materials and Methods: From May 2010 to March 2015, patients presenting with primary breast cancer had clinical examination and ultrasonography for axillary lymph node staging. The pathological results of US-guided needle biopsy and clinical data of these patients were collected and analyzed retrospectively. Results: A total of 292 (41.8%) of 698 patients confirmed the presence of axillary lymph nodes metastases. Luminal B (HER2-) and HER2 positive tumors had a higher node positivity rate than other intrinsic types. Axillary lymph nodes metastases rate indicates significant difference in each intrinsic subtype. Sixty-eight (11.5%) node-positive patients were identified by ultrasound-fine needle aspiration cytology (BUS–FNAC) and spared unnecessary sentinel lymph node biopsy (SLNB). Fifteen (14.2%) patients who had palpable lymph nodes had negative results in both FNAC and SLNB, and spared unnecessary complete axillary node clearance. Clinical examination had an accuracy of 69.1%, and EBUS-FNAC had 79.4%. Conclusion: The intrinsic subtypes are related with axillary lymph node metastasis in primary breast cancer. In comparing with clinical examination, ultrasonography evaluation for axilla status, combined with ultrasoundguided needle biopsy of suspicious axillary node is more accurate, and it is valuable prior to SLNB in primary breast cancer treatment.

Breast cancer; Intrinsic subtypes; Lymph node; Fine-needle aspiration cytology; prognosis; treatment

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