Intraoperative ultrasound guided wire(IOUS-wire) localization biopsy versus preoperative fine needle aspiration cytology(FNAC) for early breast cancer with clinically positive nodes

Background: The false-negative rate (FNR) of fine needle aspiration (FNA) for clinically positive (suspicious) lymph nodes (LNs) remains excessively high. Methods: We compared the feasibility and diagnostic efficiency of using a novel procedure to FNA for the assessment of clinically positive nodes in patients with early breast cancer. Between 1 January 2015 and 30 September 2023, 198 consecutive patients who consented to undergo axillary biopsy were referred to either the intraoperative ultrasound-guided wire localization group (IOUS-wire) or the ultrasound-guided fine needle aspiration group (US-FNAC). The primary endpoint was the false-negative rate (FNR) and accuracy rates of the two methods. One hundred patients were in the IOUS-wire group, whereas the other 98 patients were in the US-FNAC group. Results: The FNR of clinically positive lymph node biopsies was lower in the IOUS-wire localization group than in the US-FNAC group (16.1% versus 87.5%, p <0.001). Among the 32 successful identifications, 26 were in the IOUS-wire group. A total of 42 patients with additional lymph node metastases were found among FNAC-LN-negative patients by SLNB. The accuracy rates were 95% and 57.1% (p <0.001). No significant differences were observed in terms of complications or the median number of SLNs harvested between the groups. Conclusion: Compared with preoperative FNA, intraoperative US-guided wire localization biopsy is a feasible alternative procedure for cN1 patients, especially in luminal types breast cancer. This novel method is a clinical practice in China and should be further pursued as a potential biopsy method for the evaluation of axillary node status.