Fine-Needle Aspirates CYFRA 21-1 is a Useful Tumor Marker for Detecting Axillary Lymph Node Metastasis in Breast Cancer Patients

Abstract

IntroductionTo assess whether the value of CYFRA21-1 in the aspirates of ultrasonography-guided fine-needle aspiration biopsy (US-FNAB) can contribute to improving the performances of US-FNAB in the diagnosis of axillary lymph node (LN) metastasis in breast cancer patients.MethodsUS-FNAB was performed in 156 axillary LNs in 152 breast cancer patients (mean age: 51.4 years, range: 17–92 years). Concentrations of CYFRA21-1 were measured from washouts of the syringe used during US-FNAB. Tumor marker concentrations, US-FNAB, intraoperative sentinel node biopsy (SNB), and surgical pathology results were reviewed and analyzed. For comparison, the values of CEA and CA15-3 were also measured from washouts.ResultsAmong the 156 LNs, 75 (48.1%) were benign, and 81 (51.9%) were metastases. Mean concentrations of CYFRA21-1 were significantly higher in metastasis compared to benign LNs (P<0.001). US-FNAB combined to CYFRA21-1 showed significantly higher sensitivity, NPV, and accuracy compared to US-FNAB alone (all values P<0.05). All diagnostic indices of US-FNAB combined to CYFRA21-1 were significantly higher compared to US-FNAB combined with CEA or CA15-3 (all P<0.001). Of the 28 metastatic LNs which showed metastasis on SNB, CYFRA21-1 showed higher positive rate of 75.0% (CEA or CA15-3∶60.7%, P = 0.076).ConclusionMeasuring CYFRA 21-1 concentrations from US-FNAB aspirates improves sensitivity, NPV, and accuracy of US-FNAB alone, and may contribute to reducing up to 75.0% of unnecessary intraoperative SNB. Compared to CEA or CA15-3, CYFRA21-1 shows significantly higher performances when combined to US-FNAB in the preoperative diagnosis of LN metastasis in breast cancer patients.

Serum CYFRA 21-1 in Egyptian women with breast cancer

“…For surveillance of patients with diagnosed breast cancer, the most widely used serum markers are CA 15-3 and CEA which, in combination with other clinical parameters, could have clinical significance. 12 Serum CYFRA 21-1, the most sensitive tumor marker used in monitoring non-small cell lung cancer 10,11 has been reported to be detected in the peripheral blood from patients with metastatic breast cancer. 9 The present study showed that, serum CYFRA21-1 in breast cancer patients before surgery was highly elevated than that in control group.…”

“…However, little is known about this tumor marker for breast cancer. [7][8][9] Serum CYFRA 21-1, the most sensitive tumor marker used in monitoring nonsmall cell lung cancer 10,11 has been reported to be detected in the peripheral blood from patients with metastatic breast cancer and proposed to be used in monitoring disease relapse and treatment response in breast cancer patients. 9 The aim of the present study was to evaluate the clinical significance of serum CYFRA21-1 in patients with primary breast cancer by analyzing the correlation between serum CYFRA21-1 titers, clinicopathological factors and prognosis in comparison with serum CA15.3 and CEA tested in the same samples.…”

Role of [18F]Fluorodeoxyglucose Positron Emission Tomography—Computed Tomography, Sonography, and Sonographically Guided Fine–Needle Aspiration Biopsy in the Diagnosis of Axillary Lymph Nodes in Patients With Breast Cancer

“…[26][27][28][29][30][31] Many researchers have reported reliable methods for ALN staging preoperatively. 9,17,[31][32][33][34][35][36][37][38][39][40] Axillary sonography has been widely used as for preoperative evaluation of ALNs in patients with breast cancer because it can be performed simultaneously with breast sonography without much additional time and cost. 41 However, axillary sonography is operator dependent, and the detection and diagnosis of suspicious LNs by axillary sonography can be limited, especially in obese patients.…”

“…The addition of FNA can increase the specificity and PPV to 90% to 100%, 7,36,[42][43][44][45] even if FNA generates false-negative results ranging from 11.6% to 24%. 9,34,[39][40][41][45][46][47] Positron emission tomography-CT is another method that can be used for preoperative ALN staging; however, it was reported to have a lower spatial resolution and a wide range of false-positive rates (0%-15.3%). 11,[15][16][17]29,[48][49][50] Therefore, in this study, we intended to compare the diag- nostic performance of 3 modalities: sonography, sonographically guided FNA, and FDG PET-CT.…”

“…55 In addition, combined B-mode sonography and ultrasound elastography produces higher sensitivity than B-mode sonography alone in staging the ALN status. 56 Yoon et al 39 reported that sonographically guided FNA combined with evaluation of the cytokeratin fragment 21-1 concentration from FNA aspirates had a higher sensitivity, NPV, and accuracy than sonographically guided FNA alone.…”