Barw Barw Medical Journal 2960-1959 2025 08 16 Predictors of False-Negative Axillary FNA Among Breast Cancer Patients: A Cross-Sectional Study 10.58742/bmj.vi.199 eng Lana R. A. Pshtiwan Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. lana.pshtiwan@gmail.com Sakar O. Arif Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. sakar.arif@gmail.com Harzal Hiwa Fatih Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. harzal.hiwa@gmail.com Masty K. Ahmed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. masty.ahmed@gmail.com Shaban Latif Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. shaban.latif@gmail.com Meer M. Abdulkarim Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. meermohammedabdulkarim@gmail.com Hadeel A. Yasseen College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. hadeel.yasseen@gmail.com Rawa M. Ali Department of Pathology, Hospital for Treatment of Victims of Chemical Weapons, Halabja, Iraq. rawa.ali@gmail.com Ari M. Abdullah Department of Pathology, Sulaymaniyah Teaching Hospital, Sulaymaniyah, Iraq. ariabdullah1978@gmail.com Bushra O. Hussein Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. bushra.hussein@gmail.com 2025 07 12 Introduction Fine-needle aspiration (FNA) is commonly used to investigate lymphadenopathy of suspected metastatic origin. The current study aims to find the association between nodal characteristics and cancer-related factors with the rate of false-negative preoperative FNA. Methods This retrospective, single-center, cross-sectional study included breast cancer patients with negative preoperative axillary FNA results who underwent postoperative histopathological evaluation. Data were collected from electronic medical records, including clinical, imaging, cytological, and pathological findings. Patients with incomplete records, non-axillary or inconclusive FNAs, positive preoperative FNAs, or unsampled axillae postoperatively were excluded. Key variables analyzed included lymph node size, cortical thickness, tumor grade, histological type, immunohistochemical subtype, and metastatic patterns. Results A total of 209 negative axillary FNA samples were analyzed, with a mean patient age of 46.13 years. Invasive ductal carcinoma was the most common diagnosis, and ER-positive tumors were the predominant subtype. Ultrasonography identified suspicious axillary nodes in 20.57% of cases. Histopathology revealed a 27.75% false-negative rate, with a negative predictive value of 78.3%. Larger lymph node size and cortical thickness exhibited lower false-negative rates, while histologic type and ER status showed significant associations with false-negative outcomes (P < 0.05). Conclusion The 27.75% false-negative rate of preoperative FNA remains concerning and may not be sufficiently low to justify foregoing definitive axillary staging. The current study found significant associations between false-negative FNA rates and histological subtype and ER status, the latter of which is not explicitly mentioned in the literature.