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

Abstract

, 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.

Ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management

“…18,20 According to them, false-positives are mostly due to cytologic misinterpretation of cells. Conversely, recent studies reported the absence of false-positive results, [9][10][11][12][13][14] and no false-positives results from FNAC were obtained in this present study.…”

“…Other reasons for false-negative FNAC results may be sampling error, 12 and overdiagnosis with US. 13 A recent study reported that LNs < 1.2 cm in size appeared to have a significantly higher falsenegative percentage than larger LNs. 19 Ewing et al also reported that a relationship existed between the percentage of LNs replaced by carcinoma and false-negative cytology.…”

“…The characteristics of the patients are summarized in Table 1 Several studies showed the sensitivity of FNAC varying from 48% to 92%, the specificity ranging from 94% to 100%, the PPV ranging from 83% to 100%, and the NPV ranging from 59% to 78%. [9][10][11][12][13][14][15][16] False-negative rates in the literature were reported to be between 8% and 24%. [12][13][14][15][16][17][18] The main reason for false-negative FNAC results appears to be the small size of the metastasis.…”

“…[9][10][11][12][13][14][15][16] False-negative rates in the literature were reported to be between 8% and 24%. [12][13][14][15][16][17][18] The main reason for false-negative FNAC results appears to be the small size of the metastasis. 12,13,15 In this study, of the 34 cases with false-negative FNAC, 13 (38%) showed LN micrometastases, and they were not identified by FNAC.…”

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

“…If tumor cells are identified during US-FNAC or CNB, diagnosis is confirmed as metastatic ALNs. However, when the results of US-FNAC or CNB are negative, the possibility of a false negative by sampling error or overdiagnosis of AUS should be considered [ 78 , 79 ]. Because of these cases, the sensitivity can be lowered.…”