The sensitivity of pre-operative axillary staging in breast cancer: Comparison of invasive lobular and ductal carcinoma

Topps, Ashley; Clay, Vanessa; Absar, Mohammed; Howe, Miles; Lim, Yit; Johnson, R.J.; Bundred, Nigel

doi:10.1016/j.ejso.2014.03.026

Cited by 32 publications

(21 citation statements)

References 24 publications

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“…Although conflicting results exist on axillary metastasis of ILC, most studies conclude that they appear to be more in number and greater in size than IDC (7,12). Almost 30% of clinically node negative cases in this analysis had positive SLN and 43.3% (n=13) of those had additional lymph node involvement in the non-SLNs.…”

Section: Discussionmentioning

confidence: 80%

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Sentinel Lymph Node Metastasis in Invasive Lobular Carcinoma of the Breast

Güven

Kültüroğlu

Gülçelik

et al. 2018

Eur J Breast Health

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Objective: Invasive lobular carcinoma (ILC) of the breast makes up 5 to 15 percent of all invasive breast cancers. It has distinctive clinical and histopathological features when compared to invasive ductal carcinoma (IDC). This study intends to describe factors influencing sentinel lymph node (SLN) positivity in patients with "pure" ILC. Materials and Methods:Data of 105 patients, who were treated at a tertiary oncology center, with lobular carcinoma of the breast that were subjected to SLN biopsy was probed retrospectively. Patients were categorized as ≤60 and >60 years of age, positive or negative for estrogen receptor and progesterone, tumor grade I, II and III, Ki67≤15% and >30%, lymphovascular invasion presence and the presence of multicentricity and multifocality.Results: Mean age at the time of diagnosis was 52 (38-81). Mean tumor size was 2.7 cm (0.7-13cm). Univariate analyses revealed a significant relationship between tumor size (≤2 cm vs >2cm) and metastasis in the SLN. This relation kept its significance in multivariate analyses. (p=0.013). Conclusion:With so many different characteristics from IDC, ILC is mostly a uniform tumor. In this study, tumor size was the only independent clinical parameter that was found related to SLN metastases.

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Section: Discussionmentioning

confidence: 80%

“…LVI was seen in 4.7% of patients. A mean of 2 SLNs was dissected (1)(2)(3)(4)(5)(6)(7)(8) in which SLN positivity was found in 29.2% of cases. Primary surgery was a mastectomy in 73 patients, 6 with concurrent reconstruction with a silicone implant.…”

Section: Resultsmentioning

confidence: 99%

Sentinel Lymph Node Metastasis in Invasive Lobular Carcinoma of the Breast

Güven

Kültüroğlu

Gülçelik

et al. 2018

Eur J Breast Health

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“…Studies comparing the accuracy of ultrasound-guided axillary FNAB in invasive ductal versus invasive lobular carcinoma are few. Despite the higher number of positive lymph nodes associated with invasive lobular carcinoma, metastatic carcinoma may be more difficult to detect on FNAB due to the cytological resemblance of the tumor cells to lymphocytes [45]. Topps et al [45] observed that, while preoperative axillary ultrasound was equally sensitive in detecting positive axillary lymph nodes in invasive ductal and lobular carcinoma, there was a significant difference in the sensitivity of ultrasound-guided FNAB of the abnormal lymph nodes.…”

Section: Resultsmentioning

confidence: 99%

“…Despite the higher number of positive lymph nodes associated with invasive lobular carcinoma, metastatic carcinoma may be more difficult to detect on FNAB due to the cytological resemblance of the tumor cells to lymphocytes [45]. Topps et al [45] observed that, while preoperative axillary ultrasound was equally sensitive in detecting positive axillary lymph nodes in invasive ductal and lobular carcinoma, there was a significant difference in the sensitivity of ultrasound-guided FNAB of the abnormal lymph nodes. They reported a sensitivity of 98.4% for invasive ductal carcinoma compared with 53.6% for invasive lobular carcinoma and supported the use of CNB for preoperative axillary staging.…”

Section: Resultsmentioning

confidence: 99%

Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma

2019

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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.

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“…Nonetheless, remarkably, most CIS in this study were of intermediate (42%) or high grade (27%); only 5.88% of the IELs diagnosed as LCIS were grade III, whereas the same grade for DCIS had a rate of 44%. It is possible that, as proposed by the theory of the "sick lobe" (see below), DCIS lesions are more malignant than LCIS lesions and consequently have a higher probability to progress to an ICA [14,21,70,71].…”

Section: Discussionmentioning

confidence: 99%