Axillary lymph node metastasis: CA-15-3 and carcinoembryonic antigen concentrations in fine-needle aspirates for preoperative diagnosis in patients with breast cancer

Purpose: To assess whether concentrations of the tumor markers breast cancer antigen 15-3 (CA-15-3) and carcinoembryonic antigen (CEA) in fine-needle aspirates (FNAs) differ between benign and malignant lymph nodes and whether FNA concentrations of the tumor markers can improve the sensitivity of axillary lymph node (ALN) FNA in patients with breast cancer. Materials and Methods: An Institutional Review Board approved this study. All subjects gave written informed consent. Ultrasonographically (US)-guided FNA was performed for 134 ALNs in 134 women (mean age, 49.6 years; range, 28-92 years) with breast cancer. Immediately after obtaining an FNA cytology specimen, the needle was rinsed with 1 mL of normal saline solution. CEA and CA-15-3 concentrations were measured in the washout. Of the 134 ALNs, 86 were malignant and 48 were benign. Sensitivity of FNA cytology alone was compared with the sensitivity of FNA cytology and CEA and CA-15-3 FNA concentrations. Results: Patients with a positive metastatic diagnosis had significantly higher FNA concentrations of CEA and CA-15-3 than did those with a negative diagnosis (both P =.02). FNA cytology sensitivity was 87.2%, and the combined sensitivity of FNA cytology and FNA tumor marker concentrations was 96.5% ( P =.01). Conclusion: Evaluation of CEA and CA-15-3 concentrations in FNA could be helpful for the preoperative diagnosis of ALN metastasis in patients with breast cancer.