1
|
Lee HJ, Nguyen AT, Song MW, Lee JE, Park SB, Jeong WG, Park MH, Lee JS, Park I, Lim HS. Prediction of Residual Axillary Nodal Metastasis Following Neoadjuvant Chemotherapy for Breast Cancer: Radiomics Analysis Based on Chest Computed Tomography. Korean J Radiol 2023; 24:498-511. [PMID: 37271204 DOI: 10.3348/kjr.2022.0731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of chest computed tomography (CT)-based qualitative and radiomics models for predicting residual axillary nodal metastasis after neoadjuvant chemotherapy (NAC) for patients with clinically node-positive breast cancer. MATERIALS AND METHODS This retrospective study included 226 women (mean age, 51.4 years) with clinically node-positive breast cancer treated with NAC followed by surgery between January 2015 and July 2021. Patients were randomly divided into the training and test sets (4:1 ratio). The following predictive models were built: a qualitative CT feature model using logistic regression based on qualitative imaging features of axillary nodes from the pooled data obtained using the visual interpretations of three radiologists; three radiomics models using radiomics features from three (intranodal, perinodal, and combined) different regions of interest (ROIs) delineated on pre-NAC CT and post-NAC CT using a gradient-boosting classifier; and fusion models integrating clinicopathologic factors with the qualitative CT feature model (referred to as clinical-qualitative CT feature models) or with the combined ROI radiomics model (referred to as clinical-radiomics models). The area under the curve (AUC) was used to assess and compare the model performance. RESULTS Clinical N stage, biological subtype, and primary tumor response indicated by imaging were associated with residual nodal metastasis during the multivariable analysis (all P < 0.05). The AUCs of the qualitative CT feature model and radiomics models (intranodal, perinodal, and combined ROI models) according to post-NAC CT were 0.642, 0.812, 0.762, and 0.832, respectively. The AUCs of the clinical-qualitative CT feature model and clinical-radiomics model according to post-NAC CT were 0.740 and 0.866, respectively. CONCLUSION CT-based predictive models showed good diagnostic performance for predicting residual nodal metastasis after NAC. Quantitative radiomics analysis may provide a higher level of performance than qualitative CT features models. Larger multicenter studies should be conducted to confirm their performance.
Collapse
Affiliation(s)
- Hyo-Jae Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Anh-Tien Nguyen
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Won Song
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seol Bin Park
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ilwoo Park
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju, Korea
- Department of Data Science, Chonnam National University, Gwangju, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
| |
Collapse
|
2
|
The Value of Fine Needle Aspiration Biopsy in the Pre-Operative Assessment of the Axilla in Breast Cancer Patients. JOURNAL OF MOLECULAR PATHOLOGY 2022. [DOI: 10.3390/jmp3040020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This paper reviews the role of fine needle aspiration biopsy (FNAB) in assessing the axilla prior to definitive surgery or neoadjuvant therapy in breast cancer patients. The radiological criteria for biopsy are discussed and pathological techniques and pitfalls illustrated. The sensitivity and specificity of the technique and the clinical utility are addressed, with particular reference to the current controversies in the management of the axilla in the light of the American College of Surgeons Oncology Group Z0011 trial results. The low morbidity procedure of FNAB is recommended when the radiological and clinical features suggest a high yield from the abnormal axillary nodes, with consideration of core biopsy if an expected positive result is not obtained or the circumstances require tissue for ancillary studies. In conclusion, FNAB of the axilla is a highly sensitive procedure which can offer further valuable information to assist in clinical decision making. The technique is of particular value in the setting of a large primary tumour size and multiple enlarged nodes. A summary flow chart is provided to facilitate pre-operative management of the axilla and to encourage a universal approach.
Collapse
|
3
|
Bueno AP, Palu RF, Dalcin JF, Moraes LN, da Silva EC, Novaes Silva T, Saieg MA. Accuracy of fine-needle aspiration of lymph nodes: A cancer center's experience. Cytopathology 2021; 33:114-118. [PMID: 34528327 DOI: 10.1111/cyt.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Lymph node fine needle aspiration (LN-FNA) is a minimally invasive method of evaluating lymphadenopathy. Nonetheless, its use is not widely accepted due to the lack of guidelines and a cytopathological categorisation that directly relates to management. We report our experience with LN FNA at a large Cancer Center in Latin America. METHODS We retrospectively collected cytological cases of lymph node FNA from the department of pathology at AC Camargo Cancer Center performed over a 2-year period. Data extracted included LN location, age, sex and final cytological diagnosis. Patients that had undergone neoadjuvant chemotherapy and/or cases for which the surgery specimen location was not clearly reported were excluded. For those cases with surgical reports, risk of malignancy was calculated for each diagnostic category, along with overall performance of cytology. False positive cases were reviewed to assess any possible misinterpretation or sampling errors. RESULTS A total of 1730 LN-FNA were distributed as follows: 62 (3.5%) non-diagnostic (ND); 1123 (64.9%) negative (NEG), 19 (1.1%) atypical (ATY), 53 (3.1%) suspicious for malignancy (SUS), and 473 (27.3%) positive (POS). Surgical reports were available for 560 cases (32.4%). Risk of malignancy (ROM) for each category was 33.3% for ND, 29.9% for NEG, 25% for ATY, 74.2% for SUS and 99.6% for POS. Overall sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were 78.5%, 99.4%, 70.2% and 99.6%, respectively. CONCLUSION Lymph node FNA is a very specific and accurate exam, which is reliable in the detection of lymph node metastasis and other causes of lymphadenopathy.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Mauro Ajaj Saieg
- Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil.,Department of Pathology, Santa Casa Medical School, São Paulo, Brazil
| |
Collapse
|
4
|
Astvatsaturyan K, Ramazyan A, Bose S. Is ultrasound-guided fine needle aspiration biopsy of axillary lymph nodes a viable alternative to sentinel lymph node biopsy? Diagn Cytopathol 2021; 49:1099-1109. [PMID: 34264025 DOI: 10.1002/dc.24824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/31/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Axillary lymph node (ALN) ultrasound-guided fine needle aspiration biopsy (US-FNAB), a minimally invasive procedure, may be used for the preoperative evaluation of ALN status of breast cancer patients. Despite the relative ease of use and low cost, paucity of comparative studies and variation in the reported sensitivity of FNAB preclude its clinical utility in evaluation of ALNs. This study aims to determine the accuracy of US-FNAB in detecting metastasis in ALN pre-operatively and to assess US-FNAB as a viable alternative to sentinel lymph node (SLN) excision. METHODS The 228 consecutive ALN US-FNABs with subsequent histologic follow up performed from 2005 to 2020 in patients with breast carcinoma were retrospectively evaluated. FNAB results were correlated with histologic diagnosis. Sensitivity, specificity, accuracy, and risk of malignancy of FNAB were calculated. RESULTS 157/228 (69%) FNABs were concordant with histology, 37/228 (16%) discordant. Positive FNAB findings correlated with primary tumor size, grade, number of metastatic lymph nodes and size of metastases. FNAB with negative diagnosis carried a 22% risk of malignancy, atypical 43%, suspicious 80%, and positive a 100% risk of malignancy (100% positive predictive value [PPV]). The sensitivity and specificity were 78% and 95% respectively; accuracy was 77%. SLN biopsy was avoided in all 82 (36%) cases with positive FNAB results. CONCLUSION Negative FNAB result does not exclude metastatic carcinoma. With 100% PPV, full ALN dissection and/or neoadjuvant chemotherapy can be safely planned after a positive FNAB result, avoiding SLN biopsy, reducing management costs and shortening time interval to definitive therapy.
Collapse
Affiliation(s)
- Kristine Astvatsaturyan
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Arsen Ramazyan
- The University of California, Los Angeles, California, USA
| | - Shikha Bose
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
5
|
Pyo JS, Jung J, Lee SG, Kim NY, Kang DW. Diagnostic Accuracy of Fine-Needle Aspiration Cytology and Core-Needle Biopsy in the Assessment of the Axillary Lymph Nodes in Breast Cancer-A Meta-Analysis. Diagnostics (Basel) 2020; 10:E717. [PMID: 32962089 PMCID: PMC7555252 DOI: 10.3390/diagnostics10090717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The present study aims to evaluate the diagnostic accuracy between ultrasonography-guided fine-needle aspiration cytology (US-FNAC) and core needle biopsy (CNB) of axillary lymph nodes (ALNs) in patients with breast cancer through a meta-analysis and a diagnostic test accuracy (DTA) review. METHODS The present meta-analysis and DTA review included 67 eligible studies. The diagnostic accuracy of various preoperative assessments, including US-FNAC and CNB, was evaluated for ALNs assessments in patients with breast cancer. In addition, a subgroup analysis based on methods of cytologic preparation was performed. In the DTA review, the sensitivity, specificity, diagnostic odds ratio (OR) and area under the curve (AUC) on the summary receiver operating characteristic (SROC) curve were calculated. RESULTS The diagnostic accuracy of the preoperative assessments of ALNs was 0.850 (95% confidence interval (CI) 0.833-0.866) for patients with breast cancer. The diagnostic accuracy of CNB was significantly higher than that of US-FNAC (0.896, 95% CI 0.844-0.932 vs. 0.844, 95% CI 0.825-0.862; p = 0.044 in a meta-regression test). In the subgroup analysis based on cytologic preparation, the diagnosis accuracies were 0.860, 0.861 and 0.859 for the methods of conventional smear, liquid-based preparation and cell block, respectively. In the DTA review, CNB showed higher sensitivity than US-FNAC (0.849 vs. 0.760). However, there was no difference in specificity between US-FNAC and CNB (0.997 vs. 1.000). US-FNAC with liquid-based preparation and CNB showed the highest diagnostic OR and AUC on the SROC, respectively. CONCLUSION Both US-FNAC and CNB are useful in preoperative assessments of ALNs in patients with breast cancer. Although the most sensitive test was found to be CNB in this study, there was no difference in specificity between various preoperative evaluations and the application of US-FNAC or CNB may be impacted by various factors.
Collapse
Affiliation(s)
- Jung-Soo Pyo
- Department of Pathology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea;
| | - Jaehag Jung
- Department of Surgery, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea; (J.J.); (S.G.L.)
| | - Seul Gi Lee
- Department of Surgery, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea; (J.J.); (S.G.L.)
| | - Nae-Yu Kim
- Department of Internal Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea;
| | - Dong-Wook Kang
- Department of Pathology, Chungnam National University Sejong Hospital, 20 Bodeum 7-ro, Sejong 30099, Korea
- Department of Pathology, Chungnam National University School of Medicine, 266 Munhwa Street, Daejeon 35015, Korea
| |
Collapse
|
6
|
Pre-operative axillary ultrasound with fine-needle aspiration cytology performance and predictive factors of false negatives in axillary lymph node involvement in early breast cancer. Breast Cancer Res Treat 2020; 183:639-647. [PMID: 32737710 DOI: 10.1007/s10549-020-05830-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Breast cancer is the most common cancer among females worldwide. Axillary lymph node involvement is an important prognostic factor in pre-operative evaluation. The aim of this study was to evaluate the sensitivity and accuracy of AUS during the initial breast cancer diagnosis and the contribution of ultrasound with guided FNAC (AUS + FNAC) in cases of suspicious node. METHODS A retrospective study was conducted at the Lorraine Cancer Institute between 1 January and 31 December 2015. It included patients with early breast cancer, all of whom received AUS. If axillary node involvement was suspected, FNAC was performed. Sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND) were performed depending on FNAC results. RESULTS In total, 292 patients were included. 88 patients (30.1%) had a suspicious lymph node on ultrasound and had FNAC, of whom 53 tested positive for axillary node involvement (60.2%). Among the 35 patients who tested negative with FNAC, 15 had axillary metastatic involvement. Performance of AUS + FNAC was better than that of AUS alone, with sensitivity, specificity, positive predictive and negative predictive values of approximately 44.5%, 100%, 100% and 72.4%, respectively, and accuracy of approximately 77.4%. Luminal A subgroup, axillary involvement of less than two positive nodes or nodal tumor of less than 7 mm are independent factors of false negative rate. CONCLUSIONS AUS performance would seem to be improved by FNAC, with a false negative rate of approximately 26%. It may be possible to reduce the false negative rate of AUS if its contributing factors are taken into consideration, along with the impact of specific echographic signs as revealed by experienced radiologists.
Collapse
|
7
|
Kane G, Fleming C, Heneghan H, McCartan D, James P, Trueick R, Harrington L, Nally F, Quinn C, O'Doherty A, McNally S, Rothwell J, Evoy D, Geraghty J, McDermott E, Prichard R. False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients. Breast J 2019; 25:848-852. [DOI: 10.1111/tbj.13402] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/29/2018] [Accepted: 06/29/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Gavin Kane
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Christina Fleming
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Helen Heneghan
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Damian McCartan
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Philip James
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Robert Trueick
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Luke Harrington
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Fionn Nally
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Cecily Quinn
- Department of Histopathology St. Vincent's University Hospital Dublin 4 Ireland
| | - Ann O'Doherty
- Department of Radiology St. Vincent's University Hospital Dublin 4 Ireland
| | - Sorcha McNally
- Department of Radiology St. Vincent's University Hospital Dublin 4 Ireland
| | - Jane Rothwell
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Denis Evoy
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - James Geraghty
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Enda McDermott
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| | - Ruth Prichard
- Department of Breast Surgery St. Vincent's University Hospital Dublin 4 Ireland
| |
Collapse
|
8
|
Iwamoto N, Aruga T, Horiguchi S, Asami H, Saita C, Onishi M, Goto R, Ishiba T, Honda Y, Miyamoto H, Kuroi K. Ultrasound-guided fine-needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management. Diagn Cytopathol 2019; 47:788-792. [PMID: 31041851 DOI: 10.1002/dc.24203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes (LN) in breast cancer, to compare the results of FNAC and pathological examination, and to distinguish patients with 1 to 2 metastatic LNs from those with ≥3 metastatic LNs in patients with FNAC-positive patients. PATIENTS AND METHODS This study included 198 breasts of 196 patients with breast cancer who underwent FNAC and surgery for the primary and axilla without neoadjuvant chemotherapy from January 2010 to August 2016. Axillary nodal status was assessed by ultrasound (US), and whether FNAC-positive had three or more suspicious LNs on US imaging was examined. RESULTS The results of FNAC were positive in 75 (38%), negative in 97 (49%), suspicious in 2 (1%), indeterminate in 5 (2.5%), and insufficient in 19 patients (9.5%). FNAC sensitivity, specificity, positive predictive value, and negative predictive value were 62.6%, 100%, 100%, and 62.0%, respectively. Whereas 53% (18/34) of patients with false-negative FNAC had one metastatic LN on final pathology, 61% (47/77) patients who were FNAC-positive had three or more metastatic LNs. In the FNAC-positive patients, all patients had ≥3 metastatic LNs if they had ≥3 suspicious LNs on US imaging. CONCLUSION Patients with positive cytology were more likely to have ≥3 positive LNs compared to false-negative cytology patients. Patients with ≥3 abnormal LNs on US and positive FNAC might require axillary dissection.
Collapse
Affiliation(s)
- Naoko Iwamoto
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomoyuki Aruga
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Shinichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hidekazu Asami
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Chiaki Saita
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Mai Onishi
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Risa Goto
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Toshiyuki Ishiba
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yayoi Honda
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiromi Miyamoto
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Katsumasa Kuroi
- Department of Breast Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| |
Collapse
|
9
|
Gibbons CE, Quinn CM, Gibbons D. Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma. Acta Cytol 2019; 63:314-318. [PMID: 30893685 DOI: 10.1159/000496159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/10/2018] [Indexed: 01/09/2023]
Abstract
CONTEXT Fine-needle aspiration biopsy (FNAB) is frequently used to stage the axilla preoperatively in patients with primary breast carcinoma. In the light of the ACOSOG-Z0011 and AMAROS trials that specified sentinel lymph node biopsy as an inclusion criterion, the role of FNAB in axillary staging is changing. OBJECTIVE This article will review the diagnostic accuracy of FNAB in staging of the axilla in patients with primary breast carcinoma. The efficacy of axillary FNAB compared with core-needle biopsy will be evaluated. The evolving approach to staging of the axilla, in the light of ACOSOG-Z0011 and AMAROS trials, will be discussed. DATA SOURCES Data were sourced from published peer-reviewed articles in PubMed (US National Library of Medicine) and published guidelines including the European Guidelines for Quality Assurance in Breast Cancer and those from the European Society of Medical Oncology (ESMO), Union for International Cancer (UICC), American Society of Clinical Oncology (ASCO), and the American Society of Breast Surgeons. CONCLUSIONS FNAB of the axilla is almost 100% specific with a sensitivity between 40 and 90%. A positive FNAB reduces the need for a second axillary procedure by up to 20% with reduced morbidity and cost. The recent ACOSOG-Z0011 and AMAROS trials have reduced the use of FNAB axilla in American protocols, but it remains the standard of care in Europe.
Collapse
Affiliation(s)
- Ciara Ellen Gibbons
- Medicine Department, Mater Misericordiae University Hospital, Dublin, Ireland,
| | - Cecily Mary Quinn
- Pathology Department, St. Vincent's University Hospital, Dublin, Ireland
| | - David Gibbons
- Pathology Department, St. Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
10
|
Hammon M, Dankerl P, Janka R, Wachter DL, Hartmann A, Schulz-Wendtland R, Uder M, Wenkel E. Fine needle aspiration cytology of lymph nodes in breast cancer follow-up is a feasible alternative to watchful waiting and to histology. BMC WOMENS HEALTH 2015; 15:114. [PMID: 26631071 PMCID: PMC4668692 DOI: 10.1186/s12905-015-0269-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/20/2015] [Indexed: 02/05/2023]
Abstract
Background Early detection of loco-regional breast cancer recurrence improves patients’ overall survival, as treatment can be initiated or active treatment can be changed. If a suspicious lymph node is diagnosed during a follow-up exam, surgical excision is often performed. The aim of this study was to evaluate the diagnostic performance of the minor invasive ultrasound-guided fine-needle aspiration cytology (FNAC) in sonomorphologically suspicious lymph nodes in breast cancer follow-up. Methods Between April 2010 and November 2012, we performed ultrasound-guided FNAC in 38 sonographically suspicious lymph nodes of 37 breast cancer follow-up patients. Cytological specimens were evaluated if the sample material was sufficient for diagnosis and if they contained cancer cells. Patients with negative cytology were followed up clinically and sonographically. To evaluate the diagnostic performance we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for physical examination, the different sonomorphological malignancy criteria and FNAC. Results In 36/38 (94.7 %) lymph nodes, the pathologist had enough material to establish a final diagnosis; in 2/38 (5.3 %) lymph nodes, the probe material was non-evaluable during cytology, these 2 were excluded from further statistical evaluation. Cytology revealed malignancy in 21 lymph nodes and showed no evidence for malignancy in 15 lymph nodes. There was no evidence for malignant disease in follow-up exams in the 15 cytologically benign lymph nodes with an average follow-up time of 3 years. The diagnostic performances of physical examination and FNAC were: Sensitivity 52/100 %, specificity 88/100 %, PPV 85/100 %, NPV 60/100 %, respectively. Conclusions Our preliminary results show that FNAC is a safe and fast diagnostic approach for the evaluation of suspicious lymph nodes in the follow-up of patients with breast cancer and, thus, together with follow-up represents a feasible alternative to surgery.
Collapse
Affiliation(s)
- Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Peter Dankerl
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Rolf Janka
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - David L Wachter
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany.
| | - Arndt Hartmann
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany.
| | - Rüdiger Schulz-Wendtland
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Evelyn Wenkel
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| |
Collapse
|