Comparison Of Ultrasound-guided Core Needle Biopsy And Fine Needle Aspiration In Qualitatively Diagnosing Internal Mammary Node Of Breast Cancer

Objective: Internal mammary nodes(IMNs)are important drainage lymph nodes for breast cancer and their preoperatively qualitative diagnoses determine the clinical stage of breast cancer patients.Ultrasound-guided core needle biopsy(CNB)and fine needle aspiration(FNA)for suspicious lymph nodes have been widely used in qualitatively diagnosing lymph nodes,but there are few literatures on IMN puncture.This study intends to comparing the diagnostic value of CNB and FNA of IMNs in breast cancer patients.Subgroup analyses are done to find whether there are differences in IMNs with different sizes and different structural types,to provide a reference for the clinical selection of puncture method.Methods: The clinical and imaging data of 496 patients with breast cancer who received ultrasound-guided IMN-CNB or IMN-FNA in the fourth hospital of Hebei Medical University from May 2012 to October 2020 were retrospectively analyzed,including 374 cases in the CNB group and 122 cases in the FNA group.Consistency Kappa test was used to analyze the diagnostic efficacy of IMN-CNB and IMN-FNA,and Kappa value,diagnostic sensitivity,specificity and other indicators were calculated.The diagnostic efficacy of CNB and FNA of different sizes and structural types of IMNs and the factors influencing specimen satisfaction were analyzed in subgroups.Results:1.The rate of unsatisfied specimens in CNB and FNA were 5.6%(21/374)and 3.3%(4/122),respectively.The diagnostic efficiency of CNB and FNA was compared after eliminating the unsatisfactory cases,the sensitivity,specificity,positive predictive value,negative predictive value and false negative rate of the two methods were 97.3%,100%,100%,71.0%,2.7% and98.1%,100%,100%,84.6%,1.8% respectively.And the Kappa values of CNB and FNA were 0.817 and 0.907,respectively.FNA group was better than CNB group.2.Subgroup analysis of the differences between different thickness and structural types of IMNs,the results showed:(1)IMN thickness <0.5cm and0.5cm～1.0cm group,the Kappa values of CNB and FNA were 0.877,1.000 and 0.772,0.783,respectively.FNA group superior to CNB group;In the IMN thickness ≥1.0cm group,CNB was mostly performed.The CNB group had a sensitivity of 96.6% and a false-negative rate of 3.4%.The FNA group had fewer cases,with a sensitivity of 100% and a false-negative rate of 0%.(2)Among the four IMN structural types,the common ones are type II and typeⅢ.Kappa values of IMN-CNB and IMN-FNA were 0.701,1.000 and 0.824,0.864 in structural type Ⅱ and type Ⅲ respectively,showing FNA group was better than CNB group.There were few cases of structural type I and type IV of IMNs,and it was impossible to calculate the Kappa value.3.The experience of the puncture doctor was the factor affecting the specimen satisfaction rate(P<0.05),while the thickness of IMN,structural type,and puncture method didn’t(P>0.05).4.In our study,there were 4 patients with minor complications,all in the CNB group,and no complications occurred in the FNA group.Conclusions:1.Both IMN-CNB and IMN-FNA have high diagnostic efficiency,which can meet the needs of IMN qualitative diagnosis of breast cancer.2.For IMN with thickness <1.0cm,the diagnostic efficiency of FNA is higher than that of CNB,especially those thickness <0.5cm;For IMN with thickness ≥1.0cm,CNB has high diagnostic efficiency.3.For IMN with structural type II(thickened cortex)and type III(absent lymph node hilar),the diagnostic efficiency of FNA is higher than that of CNB,especially in structural type II,which the difference is significant.4.The satisfaction rate of puncture specimens is related to the experience of the puncture physician,and has no obvious correlation with the size,structural type and puncture method of IMN.The dissatisfaction rate of FNA specimens is lower than that of CNB,but the difference is not statistically significant.5.FNA is less risky than CNB,and has a lower complication rate.For IMN with special anatomical location,FNA is a safer and preferred method to obtain pathological diagnosis.6.Considering the size of IMN,common types and experience of puncture doctors,FNA is preferred for qualitative diagnosis of IMN,which has better tolerance,safety and higher diagnostic efficiency.