Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis

Balasubramanian, Ishwarya; Fleming, Christina; Corrigan, Mark; Redmond, H. P.; Kerin, Michael J.; Lowery, Aoife

doi:10.1002/bjs.10920

Cited by 68 publications

(62 citation statements)

References 34 publications

(110 reference statements)

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“…[5][6][7] From these reports, CNB provided high sensitivity and low false-negative rate. [5][6][7] From these reports, CNB provided high sensitivity and low false-negative rate.…”

Section: Introductionmentioning

confidence: 90%

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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“…[5][6][7] From these reports, CNB provided high sensitivity and low false-negative rate. [5][6][7] From these reports, CNB provided high sensitivity and low false-negative rate.…”

Section: Introductionmentioning

confidence: 90%

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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“…A recent meta‐analysis assessed complication rates after US + CNB of morphologically atypical axillary lymph nodes . Combined data from five studies showed a postprocedure complication rate of 36/502 (7.1%), with pain being the most common complication described.…”

Section: Discussionmentioning

confidence: 99%

“…Other complications included hematoma and bruising. No perinodal fibrosis was reported . Another study reviewed the operative notes and complications of US‐guided axillary lymph node 13‐gauge VAB and 14‐gauge CNB .…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we followed the rationale of guiding the CNB to the lymph node cortex, where early metastatic tumor deposits develop . However, the CEUS technique justifies and enables percutaneous CNB of small benign‐appearing lymph nodes with a very thin cortex .…”

Section: Discussionmentioning

confidence: 99%

“…Axillary ultrasonography (US) followed by fine‐needle aspiration cytology (US + FNAC) or core‐needle biopsy (US + CNB) of suspicious lymph nodes identifies approximately 50% of patients with axillary lymph node metastases . Recent reports suggest that US + CNB may be superior to US + FNAC in this setting.…”

Section: Introductionmentioning

confidence: 99%

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Perinodal fibrosis developed after ultrasonography‐guided core‐needle biopsy of a contrast‐enhanced ultrasound‐detected sentinel axillary node interferes with subsequent surgical sentinel node dissection

Serquiz

Moro

Menossi

et al. 2019

J of Clinical Ultrasound

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Objective To evaluate perinodal fibrosis after 14‐gauge staging core‐needle biopsy (CNB) of the axillary sentinel lymph node (SLN) identified using contrast‐enhanced ultrasonography (CEUS) and its interference with subsequent surgical SLN dissection in breast cancer patients. Methods Frequencies or means of main clinical, sonographic, pathological, and surgical characteristics were calculated. We also compared patient groups with and without perinodal pathological fibrosis. Results Forty‐eight patients who underwent CEUS + CNB and axillary surgery were eligible for this cross‐sectional study. Axillary surgical specimens showed perinodal fibrosis in 9/48 (18.7%) patients. Interference with SLN dissection was reported in 4/48 (8.3%) patients (two hematomas, three abnormal palpation findings, and four difficult dissections). The overall surgical detection rate of SLN was 43/48 (89.6%). In the majority of cases, perinodal fibrosis was described as moderate (4/9 [44.4%]) or severe (4/9 [44.4%]). The mean time elapsed between CEUS + CNB and axillary dissection was shorter in patients with perinodal fibrosis (P = .04). Interference with SLN dissection was only reported in patients with perinodal fibrosis (P < .001). Surgical SLN detection was successful in all nine cases in which perinodal pathological fibrosis or interference with SLN dissection was reported. Conclusion Perinodal fibrosis may impair the surgical SLN dissection in early stage breast cancer patients who were staged using CEUS + CNB using a14‐gauge needle.

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Accuracy of the International Academy of Cytology Yokohama system of breast cytology reporting for fine needle aspiration biopsy of the breast in a dedicated breast care setting

Agarwal

Singh

Mehan

et al. 2020

Diagnostic Cytopathology

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BackgroundThe International Academy of Cytology (IAC) Yokohama system is a recently proposed system for reporting breast cytology by fine needle aspiration biopsies (FNAB). Multiple studies are needed to confirm the risk of malignancy (ROM) of the various reporting categories of this system. The present article studies the accuracy of the IAC Yokohama system in our center.MethodsOver a period of 1 year (September 2018‐August 2019), all cases of breast masses assessed by FNAB and histological correlation were studied retrospectively. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) and overall accuracy of the IAC Yokohama system for diagnosing malignancy were assessed. The rates of malignancy (ROM) of each diagnostic category were also estimated.ResultsThree hundred and twenty‐one FNABs had cyto‐histological correlation. The percent sensitivity (with 95% Confidence Intervals) when the atypical, suspicious of malignancy and the malignant categories were regarded as positive for malignancy were 98.2% [95.5%, 99.5%], 96.0% [92.5%, 98.2%], and 86.7% [81.5%, 90.8%] respectively. The percent specificity (with 95% Confidence intervals) for the same categories in the same order were 59.5% [47.4%, 70.7%], 91.9% [83.2%, 97.0%], and 100% [95.1%, 100%] respectively. The area under curve (AUC) for diagnosing malignancy was 0.981[0.963, 0.993]. The ROM for the benign, atypical, suspicious of malignancy and malignant category were 8.3% [2.3%, 20.0%], 17.2% [5.8%, 35.8%], 77.8% [57.7%, 91.4%], and 100% [98.1%, 100%] respectively.ConclusionThe IAC Yokohama system is suitable for accurately reporting breast lesions on FNAB.

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Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis

Abstract: US-CNB is a superior diagnostic technique to US-FNA for axillary staging in breast cancer.

Cited by 68 publications

References 34 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

Perinodal fibrosis developed after ultrasonography‐guided core‐needle biopsy of a contrast‐enhanced ultrasound‐detected sentinel axillary node interferes with subsequent surgical sentinel node dissection

Accuracy of the International Academy of Cytology Yokohama system of breast cytology reporting for fine needle aspiration biopsy of the breast in a dedicated breast care setting

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