Nonimage-Guided Fine Needle Aspiration Biopsy of Palpable Axillary Lymph Nodes in Breast Cancer Patients

Abstract

We report the utility of office-based, nonimaged guided fine needle aspiration of palpable axillary lymph nodes in breast cancer patients. We examine the sensitivity and specificity of this procedure, and examine factors associated with a positive fine needle aspiration biopsy result. Although the utility of ultrasound-guided fine needle aspiration biopsy (FNA) of axillary lymph nodes is well established, there is little data on nonimage guided office-based FNA of palpable axillary lymphadenopathy. We investigated the sensitivity and specificity of nonimage-guided FNA of axillary lymphadenopathy in patients presenting with breast cancer, and report factors associated with a positive FNA result. Retrospective study of 94 patients who underwent office-based FNA of palpable axillary lymph nodes between 2004 and 2008 was conducted. Cytology results were compared with pathology after axillary sentinel node or lymph node dissection. Nonimage-guided axillary FNA was 86% sensitive and 100% specific. On univariate analysis, patients with positive FNA cytology had larger breast tumors (p = 0.007), more pathologic positive lymph nodes (p < 0.0001), and were more likely to present with a palpable breast mass (p = 0.006) or with radiographic lymphadenopathy (p = 0.002). FNA-positive patients had an increased presence of lymphovascular invasion (p = 0.001), higher stage of disease (p < 0.001), higher N stage (p < 0.0001), and higher rate of HER2/neu expression (p = 0.008). On multivariate analysis, radiographic lymphadenopathy (p = 0.03) and number of positive lymph nodes (p = 0.04) were associated with a positive FNA result. Nonimage-guided FNA of palpable axillary lymphadenopathy in breast cancer patients is an inexpensive, sensitive, and specific test. Prompt determination of lymph node positivity benefits select patients, permitting avoidance of axillary ultrasound, sentinel lymph node biopsy, or delay in receiving neoadjuvant therapy. This results in time and cost savings for the health care system, and expedites definitive management.

Axillary fine needle aspiration cytology is a sensitive and highly specific technique for the detection of axillary lymph node metastasis: a meta‐analysis and systematic review

“…Four studies were excluded from our study owing to our inability to calculate sensitivity or specificity from their data . Thus, a total of 32 full‐text articles in peer‐reviewed journals were included in our analysis . These studies included 3866 patients with FNAC.…”

Sparing sentinel node biopsy through axillary lymph node fine needle aspiration in primary breast cancers

“…Reported sensitivities and specificities in the literature were 40% to 87%, and 56% to 100%, respectively [16]. In the previous study by Marti et al [17], the axillary FNAC was 86% sensitive, 100% specific, and 91% accurate; PPV was 100% and NPV was 78%. Rattay et al [16] found that in FNAC of suspicious nodes to determine nodal involvement, sensitivity was 76%, specificity was 100%, PPV was 100%, and NPV was 48%.…”

Diagnostic Accuracy of Fine-Needle Aspiration Cytology and Core-Needle Biopsy in the Assessment of the Axillary Lymph Nodes in Breast Cancer—A Meta-Analysis

“…After AUS and US-FNAC, core needle biopsy (CNB) is recommended as the preoperative assessment. In daily practice, various methods are introduced for cytological preparation, such as conventional smear (CS), liquid-based preparation (LBP) and cell block [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , <...>…”