Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

Abstract

The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the diagnosis of LN metastases and subsequently in the treatment of patients with breast cancer. Axillary US was performed in 298 patients with diagnosed breast cancer (267 invasive carcinomas and 31 ductal carcinoma in situ DCIS), and in 95 patients it was followed by FNAC of US suspicious LN. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry (ICC) with a combination of anticytokeratin and anti-HMFG2 antibodies. Eighty-five FNAC were informative (49 LN were positive for metastases, 36 were negative). In 49 of 267 patients with invasive breast carcinoma (18%), a preoperative diagnosis of metastatic LN in the axilla could be confirmed. These patients could proceed directly to axillary dissection. In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN. Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination. Based on these data, US examination should be performed in all patients with breast cancer adding ICC-supported FNAC only on US-suspect LN. This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.

Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients

“…The discrepancy in that case is explained by the fact the patient was treated with neoadjuvant chemotherapy before the full lymph node dissection was performed and scarring was identified on the histologic section of 1 of the lymph nodes, presumably corresponding to a 'burnt-out' focus of metastatic carcinoma. Although some studies also report an absence of false-positive cases, 13,14 others have reported falsepositive rates of 1.4% to 1.6%. 7,11 Conclusions FNA is a sensitive and very specific method with which to detect metastases in the axillary lymph nodes of patients with breast cancer.…”

“…9 To improve the accuracy of the preoperative assessment of axillary lymph nodes, others have used FNA and found it to be simple, moderately accurate, and minimally invasive, and a good triage tool for the management of patients. 1,[7][8][9][10][11][12][13]15,19 Indeed, it has been shown that combining axillary ultrasonography with FNA cytology of abnormal lymph nodes can significantly reduce the number of unnecessary sentinel lymph node procedures performed by 8% to 40%, with a concomitant reduction in healthcare costs of up to 20%. [7][8][9][10]15,19 The data from the current study confirm that FNA cytology is a useful procedure with which to detect axillary lymph node metastases from breast carcinoma.…”

“…Different methods are used to detect metastases in axillary lymph nodes preoperatively. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Although some studies have used ultrasonographic imaging techniques alone, [2][3][4][5][6]12,17,18 others have used fine-needle aspiration (FNA) cytology with or without ultrasound guidance to improve the detection of metastases. 1,[7][8][9][10][11][12][13]15,19 FNA cytology of axillary lymph nodes is a simple, minimally invasive technique that can be utilized as a tool with which to select patients for sentinel versus full lymph node dissection procedures in We thank Dr. R. P. Michel for editorial assistance with the article.…”

Diagnostic Accuracy of Ultrasonograph Guided Fine-needle Aspiration Cytologic in Staging of Axillary Lymph Node Metastasis in Breast Cancer Patients: a Meta-analysis

“…Consequently, 44 articles included information relating FNAC and breast cancer diagnosis. But only 21 of 44 articles satisfied the requirements of the meta-analysis fully (Bonnema et al, 1997;Bedrosian et al, 2003;Deurloo et al, 2003;Kuenen-Boumeester et al, 2003;Sapino et al, 2003;Duchesne et al, 2005;Podkrajsek et al, 2005;Popli et al, 2006;van Rijk et al, 2006;Altomare et al, 2007;Ciatto et al, 2007;Alkuwari et al, 2008;Tahir et al, 2008;Baruah et al, 2010;Jung et al, 2010;Luparia et al, 2010;Carroll et al, 2011;Devaraj et al, 2011;Hayes et al, 2011;Schiettecatte et al, 2011), addressing the value of FNAC in staging of axillary lymph node in breast cancer patients. The detailed procedure was seen in Figure 1.…”

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

“…By contrast, using US-guided FNA, certain authors have demonstrated a sensitivity and specificity ranging from 42. (20)(21)(22)(23)(24)(25)(26)(27)(28). US-guided FNA has a high accuracy rate (5,7).…”