Axillary Lymph Nodes: US-guided Fine-Needle Aspiration for Initial Staging of Breast Cancer—Correlation with Primary Tumor Size

Koelliker, Susan; Chung, Maureen A.; Mainiero, Martha B.; Steinhoff, Margaret M.; Cady, Blake

doi:10.1148/radiol.2463061463

Cited by 149 publications

(148 citation statements)

References 23 publications

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“…García-Ortega et al refer 6.9% [19], Britton et al 12% [23], and Koelliker et al [24] 13%. All 5 patients had tumors between 13 and 25 mm and the primary therapeutic option was changed in all cases.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy and Impact on Management of Ultrasonography-Guided Fine-Needle Aspiration to Detect Axillary Metastasis in Breast Cancer Patients: A Prospective Study

et al. 2015

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Background: The axillary nodal status is essential to determine the stage of disease at diagnosis. Our aim was to prospectively assess the diagnostic accuracy of ultrasonography-guided fine-needle aspiration (US-FNA) for the detection of metastasis in axillary lymph nodes in patients with breast cancer (BC) and its impact on the therapeutic decision. Materials and Methods: Ultrasonography (US) was performed in 407 axillae of 396 patients who subsequently underwent surgery. US-FNA was conducted when lymph nodes were detected by US. Axillary dissection (AD) was performed when US-FNA was positive for metastasis. Patients with negative US-FNA and breast tumors of 30 mm in size were candidates for selective sentinel lymph node biopsy (SLNB). The anatomopathological results of AD or SLNB were used as reference tests. Results: Lymph nodes were detected by US in 207 (50.8%) axillae. Of these, US-FNA was performed on 180 (86.9%). 94 axillae (52.2%) were positive for carcinoma and 79 women received AD. US-FNA had 77.5% sensitivity, 100% specificity, 100% positive predictive value, 69.3% negative predictive value, and 85.1% diagnostic accuracy. US-FNA avoided SLNB in 18.1% of patients who underwent AD. Conclusions: Axillary US-FNA is an accurate technique in the staging of patients with BC. It allows reducing the number of SLNB and, when positive, offers a fast and useful tool.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy and Impact on Management of Ultrasonography-Guided Fine-Needle Aspiration to Detect Axillary Metastasis in Breast Cancer Patients: A Prospective Study

et al. 2015

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“…The combination of ultrasonography (US)-guided fi ne-needle aspiration biopsy (FNAB) and molecular analysis by using real-time reverse transcription-polymerase chain reaction is emerging as a viable, minimally invasive alternative to SLNB (10)(11)(12)(13). Although axillary US imaging can provide morphologic information, such as size and shape of lymph nodes, it cannot be used to specifi cally identify SLNs, reducing the sensitivity of US-guided FNAB ( 14 ). Noninvasive fl uorescence imaging has been used to identify SLNs by using indocyanine green dye (15)(16)(17).…”

Section: Methodsmentioning

confidence: 99%

Sentinel Lymph Nodes in the Rat: Noninvasive Photoacoustic and US Imaging with a Clinical US System

Erpelding

Kim

Pramanik³

et al. 2010

Radiology

227

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Purpose:To evaluate in vivo sentinel lymph node (SLN) mapping by using photoacoustic and ultrasonographic (US) imaging with a modifi ed clinical US imaging system. Materials and Methods:Animal protocols were approved by the Animal Studies Committee. Methylene blue dye accumulation in axillary lymph nodes of seven healthy Sprague-Dawley rats was imaged by using a photoacoustic imaging system adapted from a clinical US imaging system. To investigate clinical translation, the imaging depth was extended up to 2.5 cm by adding chicken or turkey breast on top of the rat skin surface. Three-dimensional photoacoustic images were acquired by mechanically scanning the US transducer and light delivery fi ber bundle along the elevational direction. Results:Photoacoustic images of rat SLNs clearly help visualization of methylene blue accumulation, whereas coregistered photoacoustic/US images depict lymph node positions relative to surrounding anatomy. Twenty minutes following methylene blue injection, photoacoustic signals from SLN regions increased nearly 33-fold from baseline signals in preinjection images, and mean contrast between SLNs and background tissue was 76.0 6 23.7 (standard deviation). Methylene blue accumulation in SLNs was confi rmed photoacoustically by using the optical absorption spectrum of the dye. Three-dimensional photoacoustic images demonstrate dynamic accumulation of methylene blue in SLNs after traveling through lymph vessels. Conclusion:In vivo photoacoustic and US mapping of SLNs was successfully demonstrated with a modifi ed clinical US scanner. These results raise confi dence that photoacoustic and US imaging can be used clinically for accurate, noninvasive imaging of SLNs for axillary lymph node staging in breast cancer patients.q RSNA, 2010

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“…Various studies have reported the sensitivity and specificity rates of FNAB between 25-95% and 97-100%, respectively (8,14,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). False positive results has been reported around 1.4-1.6% (20,23,30), and false negative rates as 8-12% (15,23,24,26,(29)(30)(31).…”

Section: Factors Influencing Sensitivity and Specificity Ratesmentioning

confidence: 99%

Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging

Akıncı

Bulut

Erözgen

et al. 2016

UCD

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, 46 women were prospectively enrolled in the study. Ultrasound guided-FNABs for axillary assessment were performed preoperatively. Cytology results were compared with histopathology reports to determine its sensitivity, specificity, negative and positive predictive value and accuracy.Results: Nineteen cases that had malignant cytology on FNAB also had axillary involvement in axillary lymph node dissection (ALND) without any false-positive results. The sensitivity and specificity of US-guided FNAB were 63.3% and 100%, respectively. US-guided FNAB was accurate in predicting the status of the axilla in 76.1% of patients. Conclusion:Although this technique is favorable due to its minimally invasive nature, it is not as effective as sentinel lymph node biopsy (SLNB) in terms of detecting axillary metastasis preoperatively. The low sensitivity and low accuracy rates decrease the usefulness of the technique. Therefore, it seems that US-guided FNAB alone could not replace SLNB. Nevertheless, combining some other molecular studies may be useful in increasing the technique's sensitivity. These issues should be determined by comprehensive clinical trials.Keywords: Breast cancer, axillary ultrasound, axillary staging, axillary lymph node sampling, axillary fine-needle aspiration biopsy Ulus Cerrahi Derg 2016; 32: 191-196 DOI: 10.5152/UCD.2015.2913 Original Investigation and/or ultrasound or had palpable breast lump confirmed by tru-cut biopsy as invasive breast cancer constituted the study group. ABSTRACT Patient Selection CriteriaThis study included clinically node-negative early breast cancer patients. Patients with a previous history of axillary-breast surgery and/or axillary-breast radiotherapy and those diagnosed with excisional biopsy were excluded. Patients who received neo-adjuvant chemotherapy were also excluded.All patients' demographic properties, tumor characteristics (size, grade, estrogen, progesterone receptor status, HER-2 neu status), cytopathology results of FNAB and SLNB, and post-operative pathologic findings were prospectively recorded. The FNAB, SLNB, and ALND data were compared and evaluated along with patient and tumor characteristics. Radiologic Technique and CriteriaPatients who were histopathologically diagnosed with breast cancer preoperatively were referred to the interventional radiology department for axillary lymph node FNAB. The FNABs were performed by one particular radiologist experienced in breast ultrasound before the surgical intervention, after evaluating the axillary lymph node status in gray-scale using 13.5 mHz linear probe and Hitachi Avius High Vision device.

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Axillary Lymph Nodes: US-guided Fine-Needle Aspiration for Initial Staging of Breast Cancer—Correlation with Primary Tumor Size

Abstract: US-guided FNA of axillary lymph nodes in patients with newly diagnosed breast cancer had a sensitivity that increased with increasing size of the primary tumor.

Cited by 149 publications

References 23 publications

Diagnostic Accuracy and Impact on Management of Ultrasonography-Guided Fine-Needle Aspiration to Detect Axillary Metastasis in Breast Cancer Patients: A Prospective Study

Diagnostic Accuracy and Impact on Management of Ultrasonography-Guided Fine-Needle Aspiration to Detect Axillary Metastasis in Breast Cancer Patients: A Prospective Study

Sentinel Lymph Nodes in the Rat: Noninvasive Photoacoustic and US Imaging with a Clinical US System

Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging

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