Performance characteristics of ultrasound‐guided fine‐needle aspiration of axillary lymph nodes for metastatic breast cancer employing rapid on‐site evaluation of adequacy: Analysis of 136 cases and review of the literature

Abstract

BACKGROUND: It has been demonstrated that axillary ultrasound-guided fine-needle aspiration (US-FNA) has excellent positive predictive value for the axillary lymph node status of patients with breast cancer before surgery or neoadjuvant therapy and, thus, can obviate the need for sentinel lymph node biopsy in FNA-positive patients. However, US-FNA has only moderate sensitivity, in part because of the collection of nondiagnostic or equivocal specimens. Rapid on-site evaluation for adequacy (ROSE) can improve definitive diagnosis rates but has not been well characterized in this setting. METHODS:One hundred thirty-three patients with breast carcinoma were identified who underwent 136 US-FNAs of axillary lymph nodes, all with ROSE, and the results were correlated with the diagnosis on a subsequent surgical procedure. RESULTS:The adequacy rate was 95.6% (130 of 136 FNAs), and a definitive diagnosis was made in 91.2% (124 of 136 FNAs). Among definite diagnoses, sensitivity was 75%, specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 79%. Sources of false-negative and potential false-positive diagnoses were evaluated among these cases and in the literature. CONCLUSIONS: Small metastasis size is the most common cause of falsenegative results, whereas interpretation errors by pathologists are quite rare. ROSE appears to improve adequacy and definitive diagnosis rates and, thus, can more accurately triage patients to appropriate care. Cancer (Cancer Cytopathol) 2014;122:282-91.

Comparative study between ultrasound-guided fine needle aspiration cytology of axillary lymph nodes and sentinel lymph node histopathology in early-stage breast cancer

“…This false-negative result is similar to that obtained by core-needle biopsy (thick-needle biopsy of tissue sample). In lymph nodes with small metastatic tumor deposits, it is challenging to reach this small area, and the technique is more invasive and expensive (7,15,31). Furthermore, assuring that the removed lymph node corresponds to the sentinel lymph node was not possible.…”

“…The majority of patients have clinically negative axillae. Axillary staging methods that do not require an axillary lymph node dissection have been investigated, as axillary nodal status is the most important prognostic factor and most effective indicator of long-term survival (12)(13)(14)(15). Sentinel lymph node biopsy (SNB) is the gold standard for histopathological staging of early-stage breast carcinoma, as information concerning axillary lymph node status is able to be achieved with a lower complication rate (13).…”

“…Alternative methods to replace sentinel lymph node biopsy have been assessed (15). Therefore, analysis of ultrasonographic characteristics of axillary lymph nodes, particularly ultrasound-guided fine-needle aspiration (US-guided FNA) cytology is required.…”

“…Therefore, analysis of ultrasonographic characteristics of axillary lymph nodes, particularly ultrasound-guided fine-needle aspiration (US-guided FNA) cytology is required. The main US features of suspicious lymph nodes are nodal size, cortical thickening, round morphology, hypoechogenicity, loss of central fatty hilum and eccentrically bulging cortex (15). However, thickness of the lymph node cortex is most highly associated with the presence of metastasis and may contribute to US-guided FNA (5).…”

Meme Biyopsisi: Hasta ve Yöntem Seçimi; Hangi Lezyonda Ne Yapalım?

“…Preoperatif aksilla değerlendirmede B-mod US'nin sensitivitesi %74,2, spesifitesi %78,8 iken, elastografinin sensitivitesi %80,7, spesifitesi ise %66,7, kombine kullanımda sensitivite %87,1, spesifitesi %82,2 olarak sunulmuştur [26]. Bu sonuçlar ışığında lenf nodlarında saptanan kortikal hipertrofi, asimetri, kortikal nodülarite, hilus kaybı gibi patolojilerin değerlendirilmesi için preoperatif yapılan USG kılavuzluğunda İİAB'nin yeterlilik oranı %95,6, sensitivitesi %75, spesifitesi ise %100 olarak değerlendirilmiştir [27]. KİB ve İİAB'nin karşılaştırılmasında iki yön-tem arasında anlamlı etkinlik farkı bulunmamış olup, maliyet ve komplikasyon olasılığı düşünüldüğünde aspirasyon biyopsisi tercih edilmelidir (Resim 7) [28].…”