{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T15:17:34Z","timestamp":1772983054788,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diagnostic Cytopathology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Accurate axillary staging is critical for selecting appropriate treatment strategies in breast cancer. Ultrasound (US) and ultrasound\u2010guided fine\u2010needle aspiration cytology (US\u2009+\u2009FNAC) are widely used to evaluate axillary lymph nodes. The study assessed the diagnostic accuracy of US and US\u2009+\u2009FNAC and examined whether axillary dissection (AD) is necessary in patients with positive US\u2009+\u2009FNAC findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 646 axillae from 642 breast cancer patients who underwent surgery at Hiraka General Hospital between 2013 and 2024. All patients underwent axillary US, and US\u2009+\u2009FNAC was performed on morphologically suspicious nodes. Sensitivity, specificity, PPV, and NPV of US and US\u2009+\u2009FNAC were determined using postoperative pathology as the reference standard. The number of nodal metastases was compared between patients undergoing primary surgery and those receiving primary systemic therapy (PST).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the primary surgery group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009516), US sensitivity, specificity, PPV, and NPV were 30.9% (38\/123), 94.1% (370\/393), 62.3% (38\/61), and 81.3% (370\/455), respectively. Corresponding values for US\u2009+\u2009FNAC were 80.6% (29\/36), 100% (22\/22), 100% (29\/29), and 75.9% (22\/29). US\u2009+\u2009FNAC showed significantly higher sensitivity and PPV than US alone. Among US\u2009+\u2009FNAC\u2010positive cases, 55.2% (16\/29) had \u2265\u20093 metastatic nodes, compared with 6.9% (2\/29) of negative cases. In the PST group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009130), US sensitivity was \u2264\u200988.1% (37\/42), and US\u2009+\u2009FNAC sensitivity was \u2264\u200992.6% (25\/27). Of the 46 US\u2009+\u2009FNAC\u2010positive patients, 45.7% (21\/46) became node\u2010negative after PST, whereas 26.1% (12\/46) had \u2265\u20093 positive nodes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>US\u2009+\u2009FNAC improves diagnostic accuracy for axillary staging; however, standard AD may constitute overtreatment in some FNAC\u2010positive patients. Selective de\u2010escalation of axillary surgery should therefore be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dc.70032","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T08:53:43Z","timestamp":1760604823000},"page":"30-35","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Utility and Limitations of Ultrasound\u2010Guided Axillary Lymph Node Fine\u2010Needle Aspiration Cytology in Breast Cancer Management"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2528-1852","authenticated-orcid":false,"given":"Aoi","family":"Morishita","sequence":"first","affiliation":[{"name":"Department of Breast Surgery Hiraka General Hospital  Akita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7376-4015","authenticated-orcid":false,"given":"Tomoyuki","family":"Shimada","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery Hiraka General Hospital  Akita Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.90"},{"key":"e_1_2_7_3_1","unstructured":"Japanese Breast Cancer Society \u201cThe Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer 2022 Edition (in Japanese) \u201dhttps:\/\/jbcs.xsrv.jp\/guideline\/2022\/."},{"key":"e_1_2_7_4_1","unstructured":"National Comprehensive Cancer Network (NCCN) \u201cNCCN Clinical Practice Guidelines in Oncology: Breast Cancer Version 4.2023. Plymouth Meeting (PA). National Comprehensive Cancer Network \u201d(2023) https:\/\/www.nccn.org."},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2023.3759"},{"key":"e_1_2_7_6_1","article-title":"Patient\u2010Reported Outcomes for the Intergroup Sentinel Mamma Study (INSEMA): A Randomised Trial With Persistent Impact of Axillary Surgery on Arm and Breast Symptoms in Patients With Early Breast Cancer","volume":"55","author":"Reimer T.","year":"2022","journal-title":"E Clinical Medicine"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.05.0936"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(02)00748-7"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcl.2010.06.010"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2463061463"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2012.05.008"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-010-1347-y"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012782"},{"key":"e_1_2_7_14_1","first-page":"202","article-title":"Is Sentinel Lymph Node Biopsy Necessary for All Clinically Node Negative Breast Cancer Patients?","volume":"122","author":"Hieken T.","year":"2004","journal-title":"Journal of Surgical Research"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.3122"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.215.2.r00ap20568"},{"key":"e_1_2_7_17_1","first-page":"8477","article-title":"Axillary Ultrasound and Fine Needle Aspiration Biopsy in the Preoperative Diagnosis of Axillary Metastases in Earlystage Breast Cancer","volume":"15","author":"Hu X.","year":"2018","journal-title":"Oncology Letters"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10786"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-006-9095-8"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-016-3557-3"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.24203"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-019-1753-y"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-024-03547-7"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.1772"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(02)00501-4"}],"container-title":["Diagnostic Cytopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.70032","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/dc.70032","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/dc.70032","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T09:01:11Z","timestamp":1772960471000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/dc.70032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/dc.70032"],"URL":"https:\/\/doi.org\/10.1002\/dc.70032","archive":["Portico"],"relation":{},"ISSN":["8755-1039","1097-0339"],"issn-type":[{"value":"8755-1039","type":"print"},{"value":"1097-0339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]},"assertion":[{"value":"2025-09-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}