Rapid on-site evaluation of axillary fine-needle aspiration cytology in breast cancer

O’Leary, D.P.; O’Brien, Odharnaith; Relihan, N.; McCarthy, John; Ryan, Max; Barry, Josephine; Kelly, Louise; Redmond, H. P.

doi:10.1002/bjs.8738

Cited by 19 publications

(17 citation statements)

References 23 publications

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“…However, we found an inadequate sampling rate of 19.7% (18/91), and these cases were considered nondiagnostic. O'Leary et al [18] evaluated 152 axillary FNA cases and found 80/83 cases to be adequate with ROSE versus 54/69 adequate cases without ROSE. The nondiagnostic/inadequate sampling rate could possibly be reduced by ROSE of the cytologic material by a cytopathologist [17].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Fine Needle Aspiration of Axillary Lymph Nodes in Breast Cancer: Clinical Utility, Diagnostic Accuracy and Potential Pitfalls

Gilani

Fathallah

Al-Khafaji³

2014

Acta Cytologica

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Objective: This study evaluates the diagnostic accuracy of axillary lymph node fine needle aspiration (FNA) cytology in breast cancer and correlates it with clinical parameters/outcomes. Study Design: A total of 91 females underwent FNA of axillary lymph nodes at our institution from January 2007 to February 2013. The cases were classified as ‘positive', ‘negative for malignancy' and ‘nondiagnostic'. Results: Forty-six cases (50.5%) had a histologic follow-up (4.4 ± 3.1 months); of these, 22 (47.8%) were true positive, 7 (15.2%) were true negative, 2 (4.3%) were false negative, 5 (11%) were false positive and 10 (21.7%) were nondiagnostic. However, cytological review of all false positive and false negative cases confirmed the presence or absence of tumor, respectively. All false positive cases had undergone preoperative neoadjuvant chemotherapy, with no residual tumor present, and a treatment effect identified only histologically. Meanwhile, the 2 false negative cases involved micrometastasis (≤1.5 mm). Thus, if we exclude these false positive cases (complete responders), then the sensitivity, specificity, positive predictive value and negative predictive value were 91.7, 100, 100 and 77.8%, respectively. All preoperative FNA-positive axillary lymph nodes were spared from sentinel lymph node biopsy except for 3 of 27 (11.1%). Conclusion: We suggest that axillary lymph node FNA is a highly sensitive technique with a low false negative rate (4.3%) and a diagnostic accuracy of 93.5%.

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Section: Discussionmentioning

confidence: 99%

Preoperative Fine Needle Aspiration of Axillary Lymph Nodes in Breast Cancer: Clinical Utility, Diagnostic Accuracy and Potential Pitfalls

Gilani

Fathallah

Al-Khafaji³

2014

Acta Cytologica

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“…The technique has been shown to have good diagnostic accuracy, with a sensitivity of 65–99% and a specificity of 80–100% [21]; to detect ≥3 positive nodes, sensitivity was 44.8%, specificity 95.7%, PPV 58.1%, and NPV 92.9% [20]. Rapid on-site evaluation of ALNs in aspirated specimens has been shown to be diagnostically helpful [21, 22]. USG-FNAC of ALNs has been conducted in several institutions reporting a sensitivity, specificity, PPV, and NPV of 86.4, 100, 100, and 67%, respectively [23], with an accuracy of 79%.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Ultrasound Findings and Fine-Needle Aspiration Cytology for the Diagnosis of Axillary Lymph Node Metastasis in Patients with Breast Carcinoma

et al. 2018

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Objective: Ultrasound-guided fine-needle aspiration cytology (USG-FNAC) is used for the detection of axillary lymph node (ALN) metastasis in patients with breast carcinoma (BC). US findings have a good diagnostic accuracy with high sensitivity and specificity. The aim of this study is to correlate the detection of ALN metastases on US with FNAC in BC patients. Study Design: In 75 BC patients, over a period of 9 months (January to September 2017), the size, cortical thickness (CT), presence or absence of hilar fat, and length/width ratio of ALN on US were reviewed and correlated with FNAC findings. Results: The age range was 29–78 (mean 52) years. There were 38 patients with a single ALN and 37 with multiple ALNs. ALNs with a maximum length of > 2.5 cm were malignant in 100% of cases while those ≥1.5 cm were malignant in 80.4%. ALNs with a CT of > 3 mm had metastasis in 78.1% cases. ALNs with absent hilar fat showed tumour in 87.5% cases. A length/width ratio of < 2 showed a metastatic tumour in 66.7% of aspirates. Conclusion: An association was seen between metastatic carcinoma on FNAC and axillary US features of a maximum length of ≥1.5 cm, the absence of hilar fat, and a CT of > 3 mm (p < 0.05).

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“…One possible compromise is for the radiologists to perform FNA without ROSE. Studies have shown that diagnostic accuracy of FNA improves with ROSE, 12,13 however, while it may be helpful in improving the positivity rate, it adds time to cases and is technically unnecessary for axillary lymph node evaluation, since NCCN guidelines recommend sentinel lymph node sampling for clinically suspicious lymph nodes that are negative by FNA or core needle biopsy. 2 To entertain this compromise, we are now collaborating with our radiologists on a prospective study to compare core biopsy to FNA using ThinPrep only, with the option to perform cell blocks on certain cases, such as known lobular carcinoma, to reduce false positives.…”

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confidence: 98%

Axillary lymph node FNA in women with breast cancer is a highly accurate procedure, so why are core biopsies being done?

Factor

Schmidt

Chadwick³

et al. 2015

Diagnostic Cytopathology

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Rapid on-site evaluation of axillary fine-needle aspiration cytology in breast cancer

Abstract: AUS with FNAC provided accurate preoperative staging of the axilla for metastatic breast disease and avoided unnecessary sentinel lymph node mapping. The introduction of ROSE ensured the efficiency of AUS and FNAC.

Cited by 19 publications

References 23 publications

Preoperative Fine Needle Aspiration of Axillary Lymph Nodes in Breast Cancer: Clinical Utility, Diagnostic Accuracy and Potential Pitfalls

Preoperative Fine Needle Aspiration of Axillary Lymph Nodes in Breast Cancer: Clinical Utility, Diagnostic Accuracy and Potential Pitfalls

Correlation of Ultrasound Findings and Fine-Needle Aspiration Cytology for the Diagnosis of Axillary Lymph Node Metastasis in Patients with Breast Carcinoma

Axillary lymph node FNA in women with breast cancer is a highly accurate procedure, so why are core biopsies being done?

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