Axillary lymph node <scp>FNA</scp> in women with breast cancer is a highly accurate procedure, so why are core biopsies being done?

Factor, Rachel E.; Schmidt, Robert L.; Chadwick, Barbara; Witt, Benjamin J.; Morgan, Matthew B.; Neumayer, Leigh; Layfield, Lester J.

doi:10.1002/dc.23251

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…[5][6][7] From these reports, CNB provided high sensitivity and low false-negative rate. 8 The objective of this study was to evaluate the accuracy of FNAC, to compare the results of FNAC and postoperative pathological examination, and to distinguish FNAC-positive patients with 1 to 2 metastatic LN from those with ≥3 LNs. 5 Factor et al have suggested that FNAC is a highly accurate procedure, and why are CNBs being done?…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management

Iwamoto

Aruga

Horiguchi

et al. 2019

Diagnostic Cytopathology

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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 FNACpositive 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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Section: Introductionmentioning

confidence: 99%

“…5 Factor et al have suggested that FNAC is a highly accurate procedure, and why are CNBs being done? 8 The objective of this study was to evaluate the accuracy of FNAC, to compare the results of FNAC and postoperative pathological examination, and to distinguish FNAC-positive patients with 1 to 2 metastatic LN from those with ≥3 LNs.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management

Iwamoto

Aruga

Horiguchi

et al. 2019

Diagnostic Cytopathology

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Comparison of Diagnostic Sensitivity and Procedure-Related Pain of Concurrent Ultrasound-guided Fine-needle Aspiration and Core-needle Biopsy of Axillary Lymph Nodes in Patients with Suspected or Known Breast Cancer

Winkler

Buxton

Freer

et al. 2023

Journal of Breast Imaging

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Objective Conflicting data exist on the diagnostic sensitivity of core-needle biopsy (CNB) compared to fine-needle aspiration (FNA) in the evaluation of axillary lymph node metastasis from breast cancer. Our purpose was to evaluate the sensitivity of CNB and FNA using subsequent axillary surgery as the gold standard and to compare the patients’ subjective pain levels for each biopsy method. Methods This IRB-approved prospective study enrolled 140 patients from February 2014 to May 2019 with known or suspected breast cancer. Patients underwent both US-guided FNA and 14-gauge CNB of the same node with clip placement and rated their pain level using a verbal numerical rating scale of 0 to 10. The diagnostic sensitivities were determined by pathology of the surgically excised lymph node using the McNemar test of correlated proportions. Changes in pain scores for CNB and FNA were determined using the Wilcoxon rank sum test. Results A total of 94 patients had confirmatory excision of the biopsied node with nodal metastasis detected in 71.3% (67/94). The sensitivity of CNB for detection of nodal metastasis was 95.5% (64/67), while the sensitivity of FNA was 67.2% (45/67) (P < 0.05). Overall pain score ratings for CNB increased by 0.6 from baseline on an 11-point numerical rating scale, while overall pain score rating for FNA decreased by 0.2 from baseline (P < 0.05). Conclusion Our study demonstrates that 14-gauge CNB has superior sensitivity for detection of axillary nodal metastases and mildly increased pain compared with 25-gauge FNA in patients with breast cancer.

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The Value of Fine Needle Aspiration Biopsy in the Pre-Operative Assessment of the Axilla in Breast Cancer Patients

Raymond

Kleinig

2022

JMP

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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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Axillary lymph node FNA in women with breast cancer is a highly accurate procedure, so why are core biopsies being done?

Cited by 3 publications

References 14 publications

Ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management

Ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management

Comparison of Diagnostic Sensitivity and Procedure-Related Pain of Concurrent Ultrasound-guided Fine-needle Aspiration and Core-needle Biopsy of Axillary Lymph Nodes in Patients with Suspected or Known Breast Cancer

The Value of Fine Needle Aspiration Biopsy in the Pre-Operative Assessment of the Axilla in Breast Cancer Patients

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