Axillary fine needle aspiration cytology is a sensitive and highly specific technique for the detection of axillary lymph node metastasis: a meta-analysis and systematic review

Abstract

Background: Fine needle aspiration cytology (FNAC) of axillary lymphadenopathy is a helpful tool in the pre-operative diagnosis of breast cancer patients with axillary lymphadenopathy. To date, no published meta-analysis or systematic review has been performed to assess its overall value. We therefore conducted a meta-analysis to establish the overall diagnostic value of FNAC for axillary lymph node metastasis.

Methods: After a review and quality assessment of 31 studies, published either in Chinese or English, the sensitivity, specificity and other measurements of accuracy of FNAC of axillary lymphadenopathy were pooled using random-effects models. A summary of the receiver-operating characteristic curves was used to summarize overall accuracy.

Results: We provided the following estimated values for FNAC in the diagnosis of axillary lymph node metastasis: sensitivity, 0.63 [95% confidence interval (CI), 0.61-0.65]; specificity, 0.99 (95% CI, 0.99-0.99); positive likelihood ratio, 26.52 (95% CI, 18.42-38.18); negative likelihood ratio, 0.34 (95% CI, 0.29-0.40); diagnostic odds ratio, 76.73 (95% CI, 51.98-113.28).

Conclusions: FNAC has adequate sensitivity and high specificity in the diagnosis of axillary lymph node metastasis. A positive axillary FNA result could potentially alter disease management.

Keywords: accuracy; axillary lymphadenopathy; breast cancer; fine needle aspiration cytology; lymph node; meta-analysis.