Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients

Barco, Israel; Chabrera, Carolina; García-Fernández, Antonio; Fraile, Manel; González, Sónia; Canales, Lidia; Lain, J. M.; González, Carles Benedí; Vidal, M.; Vallejo, Elena; Deu, J.; Pessarrodona, Antoni; Giménez, Núria; Font, Marc García

doi:10.1007/s12094-016-1589-7

Cited by 32 publications

(31 citation statements)

References 22 publications

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“…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.…”

Section: Resultscontrasting

confidence: 87%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultscontrasting

confidence: 87%

Section: Resultsmentioning

confidence: 99%

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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“…Similarly, Caudle et al [13] and Boone et al [14] report 52 and 50% of patients, respectively, possessed low nodal burden following positive pre-operative ultrasound on ANC. Other studies report lower but still significant ranges for this patient subgroup ranging between 25 [15] and 48% [16][17][18]. These studies demonstrate that pre-operative axillary ultrasound is not currently sufficiently specific to identify clinically relevant high nodal burden, and its role in stratifying patients to 'fast-track' ANC leads to overtreatment in up to two-thirds of patients.…”

mentioning

confidence: 76%

“…Other imaging modalities have so far not been shown to be credible alternatives with high false positive rates being recorded for MRI [25] and when combined with ultrasound no improvement in sensitivity or specificity identified [16]. Positron emission topography (PET) or PET/CT has been reported to possess a mean sensitivity and specificity of 63 and 94%, respectively, for the determination of axillary lymph node status in early breast cancer [26].…”

mentioning

confidence: 99%

Is there a role for sentinel node biopsy in the pre-operative ultrasound positive axilla?

Ahmed

Jozsa

Douek

2017

Breast Cancer Res Treat

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Axillary management in breast cancer is becoming increasingly conservative. This approach is based on the identification of low axillary burden on sentinel node biopsy (SNB). The modern practice of routine pre-operative axillary ultrasound has meant that patients are 'fast tracked' to axillary node clearance (ANC) in the presence of a histologically confirmed positive axilla. This practice reduces the number of patients undergoing SNB compared to the original trials, which evaluated the role of SNB, and those assessing safety of omission of ANC in low axillary burden. The risk of depriving patients with low axillary burden the opportunity to avoid ANC as a consequence of pre-operative ultrasound is discussed.

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“…In a retrospective cohort of 1538 breast cancer patients (Barco et al 2016 [4]), 1151 were AUS-negative and, at SNB, 95.7% had low nodal burden. Boone et al (2015) [5] and Moorman et al (2014) [6] reported 96.0% (n = 434) and 95.8% (n = 879) of AUS-negative patients respectively with low nodal burden at SNB.…”

Section: The Clinical Value Of a Pre-operative Negative Axillary Ultrmentioning

confidence: 99%

Is sentinel node biopsy necessary in the radiologically negative axilla in breast cancer?

Jozsa

Ahmed

Baker

et al. 2019

Breast Cancer Res Treat

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Purpose The steady move towards axillary conservatism in breast cancer is based on studies demonstrating that axillary node clearance affords no survival benefit in a subset of patients with a positive pre-operative axillary ultrasound (AUS). However, less attention has been paid to AUS-negative patients who receive sentinel node biopsy as standard. Methods Previously assembled systematic review data was reassessed to evaluate nodal burden amongst patients with breast cancer and a clinically and radiologically negative axilla. Results Pooled data from four cohort studies reporting pre-operative axillary ultrasound in 5139 patients with breast cancer show it has a negative predictive rate of 0.951 (95% confidence interval 0.941-0.960). Conclusions Reconsidering the use of ultrasound in patients with early breast cancer and non-palpable axillae reveals that sentinel node biopsy itself may represent surgical over-treatment in patients with a negative axillary ultrasound. The implications of this on the future of surgical management of the axilla are discussed.

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Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients

Abstract: We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.

Cited by 32 publications

References 22 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

Is there a role for sentinel node biopsy in the pre-operative ultrasound positive axilla?

Is sentinel node biopsy necessary in the radiologically negative axilla in breast cancer?

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