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Yel I, D'Angelo T, Gruenewald LD, Koch V, Golbach R, Mahmoudi S, Ascenti G, Blandino A, Vogl TJ, Booz C, Bucolo GM. Dual-Energy CT Material Decomposition: The Value in the Detection of Lymph Node Metastasis from Breast Cancer. Diagnostics (Basel) 2024; 14:466. [PMID: 38472939 DOI: 10.3390/diagnostics14050466] [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: 01/31/2024] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based material decomposition algorithm for iodine quantification and fat fraction analysis to detect lymph node metastases in breast cancer patients. MATERIALS AND METHODS 30 female patients (mean age, 63.12 ± 14.2 years) diagnosed with breast cancer who underwent pre-operative chest DECT were included. To establish a reference standard, the study correlated histologic repots after lymphadenectomy or confirming metastasis in previous/follow-up examinations. Iodine concentration and fat fraction were determined through region-of-interest measurements on venous DECT iodine maps. Receiver operating characteristic curve analysis was conducted to identify the optimal threshold for differentiating between metastatic and non-metastatic lymph nodes. RESULTS A total of 168 lymph nodes were evaluated, divided into axillary (metastatic: 46, normal: 101) and intramammary (metastatic: 10, normal: 11). DECT-based fat fraction values exhibited significant differences between metastatic (9.56 ± 6.20%) and non-metastatic lymph nodes (41.52 ± 19.97%) (p < 0.0001). Absolute iodine concentrations showed no significant differences (2.25 ± 0.97 mg/mL vs. 2.08 ± 0.97 mg/mL) (p = 0.7999). The optimal fat fraction threshold for diagnosing metastatic lymph nodes was determined to be 17.75%, offering a sensitivity of 98% and a specificity of 94%. CONCLUSIONS DECT fat fraction analysis emerges as a promising method for identifying metastatic lymph nodes, overcoming the morpho-volumetric limitations of conventional CT regarding lymph node assessment. This innovative approach holds potential for improving pre-operative lymph node evaluation in breast cancer patients, offering enhanced diagnostic accuracy.
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Affiliation(s)
- Ibrahim Yel
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Leon D Gruenewald
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Vitali Koch
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Rejane Golbach
- Institute of Biostatistics and Mathematical Modelling, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Scherwin Mahmoudi
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Thomas J Vogl
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Christian Booz
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Clinic for Radiology and Nuclear Medicine, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Giuseppe M Bucolo
- Division of Experimental Imaging, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
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Loonis AST, Chesebro AL, Bay CP, Portnow LH, Weiss A, Chikarmane SA, Giess CS. Positive predictive value of axillary lymph node cortical thickness and nodal, clinical, and tumor characteristics in newly diagnosed breast cancer patients. Breast Cancer Res Treat 2024; 203:511-521. [PMID: 37950089 DOI: 10.1007/s10549-023-07155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Axillary lymph nodes (LNs) with cortical thickness > 3 mm have a higher likelihood of malignancy. To examine the positive predictive value (PPV) of axillary LN cortical thickness in newly diagnosed breast cancer patients, and nodal, clinical, and tumor characteristics associated with axillary LN metastasis. METHODS Retrospective review of axillary LN fine needle aspirations (FNAs) performed 1/1/2018-12/31/2019 included 135 axillary FNAs in 134 patients who underwent axillary surgery. Patient demographics, clinical characteristics, histopathology, and imaging features were obtained from medical records. Hypothesis testing was performed to identify predictors of axillary LN metastasis. RESULTS Cytology was positive in 72/135 (53.3%), negative in 61/135 (45.2%), and non-diagnostic in 2/135 (1.5%). At surgery, histopathology was positive in 84 (62.2%) and negative in 51 (37.8%). LN cortices were thicker in metastatic compared to negative nodes (p < 0.0001). PPV of axillary LNs with cortical thickness ≥ 3 mm, ≥ 3.5 mm, ≥ 4 mm and, ≥ 4.25 mm was 0.62 [95% CI 0.53, 0.70], 0.63 [0.54, 0.72], 0.67 [0.57, 0.76] , and 0.74 [0.64, 0.83], respectively. At multivariable analysis, abnormal hilum (OR = 3.44, p = 0.016) and diffuse cortical thickening (OR = 2.86, p = 0.038) were associated with nodal metastasis. CONCLUSION In newly diagnosed breast cancer patients, increasing axillary LN cortical thickness, abnormal fatty hilum, and diffuse cortical thickening are associated with nodal metastasis. PPV of axillary LN cortical thickness ≥ 3 mm and ≥ 3.5 mm is similar but increases for cortical thickness ≥ 4 mm. FNA of axillary LNs with cortex < 4 mm may be unnecessary for some patients undergoing sentinel LN biopsy.
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Affiliation(s)
- Anne-Sophie T Loonis
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Allyson L Chesebro
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Camden P Bay
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Leah H Portnow
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Anna Weiss
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Division of Surgical Oncology, Department of Surgery, University of Rochester, Rochester, NY, USA
| | - Sona A Chikarmane
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Catherine S Giess
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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Lan Z, Zhang J, Li J, He R. Utility of GATA-3 immunocytochemistry for the assessment of fine-needle aspiration in breast cancer patients with suspicious axillary lymph nodes at ultrasound. Diagn Cytopathol 2024; 52:93-102. [PMID: 37964714 DOI: 10.1002/dc.25252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Ultrasound-guided fine-needle aspiration cytology (FNAC) is a routine preoperative method for evaluating suspicious axillary lymph nodes (ALNs) in patients with breast cancer. However, a range of reasons such as morphological pitfalls, technical artifacts, and sampling errors restrict the sensitivity and accuracy of FNAC. This retrospective study investigated the diagnostic value of GATA-binding protein 3 (GATA-3) immunocytochemistry for FNAC. METHODS Breast cancer patients who underwent preoperative FNAC for suspicious ALNs, relevant GATA-3 immunocytochemistry, and postoperative status of ALNs were reviewed from the period of March 2020 to February 2022. Altogether, 102 patients were included in the study. FNAC material smears stained with hematoxylin and eosin was initially assessed by two cytopathologists and categorized into five groups: nondiagnostic, negative, atypical, suspicious, and positive for malignancy. Only group of cells positive for malignancy was considered positive. For each case, two selected slides were digitized (whole slide imaged) at ×40 magnification and decolored for GATA-3 immunocytochemistry. The expression of GATA-3 was scored ranging from 0 to 9 (Score ≥3: Positive, Score ≤2: Negative). If either FNAC or GATA-3 immunocytochemistry was positive or the combined test positive, then the case was considered positive. The sensitivity, specificity, and accuracy of FNAC, GATA-3 immunocytochemistry, and combined FNAC/GATA-3 immunocytochemistry were analyzed by χ2 and Fisher's tests. RESULTS The mean age of the study participants was 50.62 (ranging: 30-73 years). Invasive breast carcinoma (not otherwise specified) accounted for most histological subtypes, and grade 2 was the leading Nottingham grade. Sixteen cases directly underwent mastectomy while the other 86 patients had neoadjuvant therapy. A more serious diagnosis was made based on GATA-3 detection in 22.5% (n = 23) of 102 cases. Of the 23 cases, metastasis was confirmed by GATA-3 detection in 21 cases, and an uncertain diagnosis was ascertained based on GATA-3 immunocytochemistry in 2 with nondiagnostic FNAC results. The sensitivity (77/87, 88.5%) of GATA-3 detection for distinguishing malignancies from benign lesions was higher than that of FNAC alone (62/87, 71.3%) (p < .05). CONCLUSIONS GATA-3 immunocytochemistry exhibited high diagnostic efficacy in distinguishing malignant breast cancer cells. Moreover, combined FNAC and GATA-3 immunocytochemistry achieved optimal results in terms of reducing the false-negative rate and promoting accuracy.
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Affiliation(s)
- Zhihua Lan
- Department of Pathology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jing Zhang
- Department of Pathology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jianping Li
- Department of Pathology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Rongfang He
- Department of Pathology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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Ionică M, Ilina RȘ, Neagoe OC. Ultrasound Pretreatment Lymph Node Evaluation in Early-Stage Breast Cancer: Should We Biopsy High Suspicion Nodes? Clin Pract 2023; 13:1532-1540. [PMID: 38131683 PMCID: PMC10742685 DOI: 10.3390/clinpract13060134] [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: 09/18/2023] [Revised: 11/05/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND With the growing incidence of breast cancer, efficient and correct staging is essential for further treatment decisions. Axillary ultrasound (US) remains the most common method for regional nodal involvement assessment. The aim of this study was to evaluate whether high-risk US features can accurately predict axillary lymph node metastasis. METHODS A total of 150 early-stage breast cancer patients (T1 or T2) were prospectively included in the study. Based on axillary US, patients were classified as normal, low-risk, or high-risk, with all patients in the low-risk and high-risk groups undergoing fine-needle aspiration (FNAB) and core-needle biopsies. RESULTS For the low-risk US group, a lower prediction rate of axillary nodal metastasis was achieved than for the group with high-risk features, recording a sensitivity of 66.6% vs. 89.2%, a specificity of 57.1% vs. 100%, a positive predictive value (PPV) of 26.6% vs. 100%, a negative predictive value (NPV) of 88% for both groups, and an accuracy of 58.9% vs. 94%, respectively. FNAB resulted in more false-negative results compared to core-needle biopsy in both low-risk and high-risk US groups. CONCLUSIONS Our findings suggest that high-risk US features can predict axillary lymph node metastasis with high accuracy.
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Affiliation(s)
- Mihaela Ionică
- Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical Municipal Hospital, 300079 Timișoara, Romania; (R.Ș.I.); (O.C.N.)
- Second Discipline of Surgical Semiology, First Department of Surgery, ”Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Breast Surgery Research Center, ”Victor Babeș” University of Medicine and Pharmacy, 300079 Timișoara, Romania
| | - Răzvan Ștefan Ilina
- Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical Municipal Hospital, 300079 Timișoara, Romania; (R.Ș.I.); (O.C.N.)
- Second Discipline of Surgical Semiology, First Department of Surgery, ”Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Breast Surgery Research Center, ”Victor Babeș” University of Medicine and Pharmacy, 300079 Timișoara, Romania
| | - Octavian Constantin Neagoe
- Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical Municipal Hospital, 300079 Timișoara, Romania; (R.Ș.I.); (O.C.N.)
- Second Discipline of Surgical Semiology, First Department of Surgery, ”Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Breast Surgery Research Center, ”Victor Babeș” University of Medicine and Pharmacy, 300079 Timișoara, Romania
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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.
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Sun X, Niwa T, Ozawa S, Endo J, Hashimoto J. Detecting lymph node metastasis of esophageal cancer on dual-energy computed tomography. Acta Radiol 2022; 63:3-10. [PMID: 33325727 PMCID: PMC9530532 DOI: 10.1177/0284185120980144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Using conventional computed tomography (CT), the accurate diagnosis of lymph
node (LN) metastasis of esophageal cancer is difficult. Purpose To examine dual-energy CT parameters to predict LN metastasis preoperatively
in patients with esophageal cancer. Material and Methods Twenty-six consecutive patients who underwent dual-energy CT before an
esophageal cancer surgery (19 patients with LN metastases) were analyzed.
The included LNs had a short-axis diameter of ≥4 mm and were confirmed to be
resected on postoperative CT. Their short-axis diameter, CT value, iodine
concentration (IC), and fat fraction were measured on early- and late-phase
contrast-enhanced dual-energy CT images and compared between pathologically
confirmed metastatic and non-metastatic LNs. Results In total, 51 LNs (34 metastatic and 17 non-metastatic) were included. In the
early phase, IC and fat fraction were significantly lower in the metastatic
than in the non-metastatic LNs (IC = 1.6 mg/mL vs. 2.2 mg/mL; fat
fraction = 20.3% vs. 32.5%; both P < 0.05). Furthermore,
in the late phase, IC and fat fraction were significantly lower in the
metastatic than in the non-metastatic LNs (IC = 2.0 mg/mL vs. 3.0 mg/mL; fat
fraction = 20.4% vs. 33.0%; both P < 0.05). Fat fraction
exhibited accuracies of 82.4% and 78.4% on early- and late-phase images,
respectively. Conversely, short-axis diameter and CT value on both early-
and late-phase images were not significantly different between the
metastatic and non-metastatic LNs (P > 0.05). Conclusion Using dual-energy CT images, IC and fat fraction are useful for diagnosing LN
metastasis in patients with esophageal cancer.
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Affiliation(s)
- Xuyang Sun
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsu Niwa
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Jun Endo
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
| | - Jun Hashimoto
- Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan
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Sechel G, Rogozea LM, Roman NA, Ciurescu D, Cocuz ME, Manea RM. Analysis of breast cancer subtypes and their correlations with receptors and ultrasound. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 62:269-278. [PMID: 34609431 PMCID: PMC8597389 DOI: 10.47162/rjme.62.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The study aim was to evaluate the ultrasound (US) signs of the mammary lesions classified in the Breast Imaging-Reporting and Data System (BI-RADS) score category 3, 4, and 5, corresponding to US BI-RADS. It also followed the correlation between US changes of lesions suggestive for malignancy with the histopathological results and evaluated the proper management of those lesions. There were correlations of breast cancer (BC) subtypes with the receptors [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)], and Ki67 index, and the signs of conventional ultrasonography and US elastography. We selected 108 female patients examined with US, mammography and fine-needle biopsy who presented suspicions for malignancy lesions. Following the immunohistochemical analysis, they were classified in one of the BC subtypes. According to chi-squared analysis of molecular cancer subtypes correlation to receptors and Ki67 index, we found significant associations between both luminal A and luminal B HER2-negative subtypes and hormone receptors (ER, PR). These have an inverse relationship with Ki67 index elevated values; luminal B HER2-positive subtype has a direct association with HER2 presence; HER2-enriched subtype was statistically significant associated to HER2 presence and elevated Ki67 index values but had an inverse relationship to hormone receptors (ER, PR); triple-negative subtype was strongly associated to Ki67 index values and inversely correlated to ER and PR. We found luminal A subtype as being the most common and luminal B HER2-positive subtype as having the fewer cases.
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Affiliation(s)
- Gabriela Sechel
- Department of Basic, Preventive and Clinical Sciences, Faculty of Medicine, Transilvania University of Braşov, Romania;
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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.
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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
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Axillary Nodal Metastases in Invasive Lobular Carcinoma Versus Invasive Ductal Carcinoma: Comparison of Node Detection and Morphology by Ultrasound. AJR Am J Roentgenol 2021; 218:33-41. [PMID: 34319162 DOI: 10.2214/ajr.21.26135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Invasive lobular carcinoma is more subtle on imaging compared with invasive ductal carcinoma; nodal metastases may also differ on imaging between these. Objective: To determine whether invasive lobular carcinoma and invasive ductal carcinoma differ in the detection rate by ultrasound (US) of metastatic axillary nodes and in metastatic nodes' US characteristics. Methods: This retrospective study included 695 women (median age 53 years) with breast cancer in a total of 723 breasts (76 lobular, 586 ductal, 61 mixed), with biopsy-proven axillary nodal metastases and who underwent pretreatment US. A single breast radiologist reviewed US images in patients with suspicious nodes on US and classified node number, size, and morphology. Morphologic assessment used a previously described classification based on the relationship between node cortex and hilum. Nodal findings were compared between lobular and ductal carcinoma. A second radiologist independently classified node morphology in 241 cancers to assess interreader agreement. Results: A total of 99 metastatic axillary nodes (15 lobular, 66 ductal, 18 mixed) were not visualized on US and were diagnosed by surgical biopsy. The remaining 624 metastatic nodes (61 lobular, 520 ductal, 43 mixed) were visualized on US and diagnosed by US-guided FNA. Thus, US detected the metastatic nodes in 80.3% for lobular carcinoma versus 88.7% for ductal carcinoma (p=.04). Among metastatic nodes detected by US, retrospective review identified ≥3 abnormal nodes in 50.8% of lobular carcinoma versus 69.2% of ductal carcinoma (p=.003); node size was ≤2.0 cm in 65.6% for lobular carcinoma versus 47.3% for ductal carcinoma (p=.03); morphology was type III/IV (diffuse cortical thickening without hilar mass effect) rather than type V/VI (marked cortical thickening with hilar mass effect) in 68.9% for lobular carcinoma versus 28.8% for ductal carcinoma (p<.001). Interreader agreement assessment for morphology exhibited kappa coefficient of 0.63 (95% CI, 0.54-0.73). Conclusion: US detects a lower percentage of nodal metastases in lobular than ductal carcinoma. Nodal metastases in lobular carcinoma more commonly show diffuse cortical thickening and with less hilar mass effect. Clinical Impact: A lower threshold may be warranted to recommend biopsy of suspicious axillary nodes detected on US in patients with lobular carcinoma.
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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.
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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
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Layfield LJ, Zhang T, Esebua M, Schmidt R. Axillary lymph node metastasis: Fine-needle aspiration biopsy sensitivity as a function of node size, percent replacement of lymph node by tumor and tumor deposit size. Diagn Cytopathol 2020; 49:181-186. [PMID: 32945140 DOI: 10.1002/dc.24617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/24/2020] [Accepted: 08/11/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is commonly used to investigate lymphadenopathy of suspected metastatic origin. While diagnostic accuracy of FNA for lymph node disease is well described, the relationship between node size, percent tumor replacement, and size of metastatic deposit with diagnostic accuracy is less well documented. METHODS All axillary lymph nodes undergoing ultrasound-guided FNA for suspected breast metastases were correlated with subsequent surgical excision specimens. FNAs were judged as positive or negative for malignancy and the percent of false negative FNAs was correlated with node size, percent tumor replacement and size of metastatic deposit RESULTS: Sensitivities were calculated for nodes greater than 15 mm (92%), nodes 11 to 14.9 mm (83%), nodes 7 to 10.9 mm (61%), and for nodes less than 7 mm (60%). Sensitivity increases with increasing node size (P = .001). Percent tumor replacement correlated with sensitivity: 90% or greater replacement (85%) 60% to 89.9% replacement (75%), 40% to 59.9% replacement (75%) and less than 39.9% replacement (64%)(P < .001). Metastases size correlated with sensitivity: metastases greater than 10 mm (94%), 6 to 9.9 mm (70%), 4 to 5.9 mm (54%), and less than 4 mm (72%). CONCLUSIONS Percentage of false negative FNAs associate with investigation of metastatic disease correlates with node size, size of metastatic deposit and percentage of nodes replaced by tumor. Lymph nodes smaller than 7 mm, deposit diameter less than 6 mm and percentage replacement of less than 40% have the highest percentage of false negative results.
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Affiliation(s)
- Lester J Layfield
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Tao Zhang
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Magda Esebua
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Robert Schmidt
- Department of Pathology and Laboratory Medicine, University of Utah & ARUP Laboratories, Salt Lake City, Utah, USA
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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.
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Iwamoto N, Aruga T, Asami H, Horiguchi SI. False-negative ultrasound-guided fine-needle aspiration of axillary lymph nodes in breast cancer patients. Cytopathology 2020; 31:463-467. [PMID: 32568448 DOI: 10.1111/cyt.12877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The purpose of this study was to clarify the clinicopathological features of patients with false-negative fine needle aspiration cytology (FNAC) and to determine the factors associated with negative FNAC. METHODS Patients with negative FNAC from January 2010 to December 2019 were included. The patients with positive sentinel nodes (SN) were divided into two groups: micrometastasis (≤2 mm) group and macrometastasis (>2 mm) group. The clinicopathological characteristics were compared between the two groups using the χ2 test. RESULTS A total of 165 patients with negative FNAC were included; 52 (31.5%) had positive SNs. Of the 52 patients, 13 (25%) had micrometastasis and the remaining 39 (75%) had macrometastasis. Of the 113 patients with negative SNs, none had metastases found in non-SNs. No significant differences were observed in age, cT stage or subtype, and preoperative ultrasound findings between the two groups. CONCLUSIONS The false-negative rate of FNAC was high (31.5%). Micrometastatic disease was seen in patients with negative FNAC, and this might be the cause of false-negative FNAC results.
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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
| | - Hidekazu Asami
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Shin-Ichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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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
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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.
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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
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Chen CF, Zhang YL, Cai ZL, Sun SM, Lu XF, Lin HY, Liang WQ, Yuan MH, Zeng D. Predictive Value of Preoperative Multidetector-Row Computed Tomography for Axillary Lymph Nodes Metastasis in Patients With Breast Cancer. Front Oncol 2019; 8:666. [PMID: 30671386 PMCID: PMC6331431 DOI: 10.3389/fonc.2018.00666] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/17/2018] [Indexed: 02/05/2023] Open
Abstract
Introduction: Axillary lymph nodes (ALN) status is an essential component in tumor staging and treatment planning for patients with breast cancer. The aim of present study was to evaluate the predictive value of preoperative multidetector-row computed tomography (MDCT) for ALN metastasis in breast cancer patients. Methods: A total of 148 cases underwent preoperative MDCT examination and ALN surgery were eligible for the study. Logistic regression analysis of MDCT variates was used to estimate independent predictive factors for ALN metastasis. The prediction of ALN metastasis was determined with MDCT variates through receiver operating characteristic (ROC) analysis. Results: Among the 148 cases, 61 (41.2%) cases had ALN metastasis. The cortical thickness in metastatic ALN was significantly thicker than that in non-metastatic ALN (7.5 ± 5.0 mm vs. 2.6 ± 2.8 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of >3 mm (OR: 12.32, 95% CI: 4.50–33.75, P < 0.001) and non-fatty hilum (OR: 5.38, 95% CI: 1.51–19.19, P = 0.009) were independent predictors for ALN metastasis. The sensitivity, specificity and AUC of MDCT for ALN metastasis prediction based on combined-variated analysis were 85.3%, 87.4%, and 0.893 (95% CI: 0.832–0.938, P < 0.001), respectively. Conclusions: Cortical thickness (>3 mm) and non-fatty hilum of MDCT were independent predictors for ALN metastasis. MDCT is a potent imaging tool for predicting ALN metastasis in breast cancer. Future prospective study on the value of contrast enhanced MDCT in preoperative ALN evaluation is warranted.
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Affiliation(s)
- Chun-Fa Chen
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yu-Ling Zhang
- Department of Information, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Ze-Long Cai
- Department of Medical Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shu-Ming Sun
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiao-Feng Lu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hao-Yu Lin
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wei-Quan Liang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ming-Heng Yuan
- Cancer Research Center, Shantou University Medical College, Shantou, China
| | - De Zeng
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
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Kapila K, Alath P, Hebbar GH, Jaragh M, George SS, AlJassar A. Correlation of Ultrasound Findings and Fine-Needle Aspiration Cytology for the Diagnosis of Axillary Lymph Node Metastasis in Patients with Breast Carcinoma. Acta Cytol 2018; 63:17-22. [PMID: 30517932 DOI: 10.1159/000493635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/10/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Ultrasound-guided fine-needle aspiration cytology (USG-FNAC) is used for the detection of axillary lymph node (ALN) metastasis in patients with breast carcinoma (BC). US findings have a good diagnostic accuracy with high sensitivity and specificity. The aim of this study is to correlate the detection of ALN metastases on US with FNAC in BC patients. STUDY DESIGN In 75 BC patients, over a period of 9 months (January to September 2017), the size, cortical thickness (CT), presence or absence of hilar fat, and length/width ratio of ALN on US were reviewed and correlated with FNAC findings. RESULTS The age range was 29-78 (mean 52) years. There were 38 patients with a single ALN and 37 with multiple ALNs. ALNs with a maximum length of > 2.5 cm were malignant in 100% of cases while those ≥1.5 cm were malignant in 80.4%. ALNs with a CT of > 3 mm had metastasis in 78.1% cases. ALNs with absent hilar fat showed tumour in 87.5% cases. A length/width ratio of < 2 showed a metastatic tumour in 66.7% of aspirates. CONCLUSION An association was seen between metastatic carcinoma on FNAC and axillary US features of a maximum length of ≥1.5 cm, the absence of hilar fat, and a CT of > 3 mm (p < 0.05).
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Affiliation(s)
- Kusum Kapila
- Cytopathology Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait,
| | - Preetha Alath
- Department of Cytology, Kuwait Cancer Control Center, Safat, Kuwait
| | - Govind H Hebbar
- Department of Radiology, Kuwait Cancer Control Center, Safat, Kuwait
| | - Mohammed Jaragh
- Department of Cytology, Kuwait Cancer Control Center, Safat, Kuwait
| | - Sara S George
- Cytopathology Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Ayesha AlJassar
- Department of Cytology, Kuwait Cancer Control Center, Safat, Kuwait
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