In 2020, the COVID-19 pandemic is the major healthcare concern around the world. The infection is especially severe to those with immune system suppression, including patients with cancer. In order to mitigate the negative effects of COVID-19, guidelines have been developed by societies worldwide to review oncology care during this pandemic time. Neoadjuvant endocrine therapy (NET) is a well-stablished option for hormone positive (HR) HER2 negative breast cancer and showed a positive response in breast conservative surgery with substantially less toxicity. Compared to chemotherapy, the NET cost is lower, and its administration is easier, due to less medical visits. Even with remarkable advantages, NET remains taking less place in treatments than it might have. Periods of humanity crisis, such as World Wars and other pandemics, boosted the development of science and established many treatments, which are currently practiced. New data generated during the COVID-19 outbreak can inspire more trials comparing chemotherapy to endocrine therapy within the neoadjuvant setting. The purpose of this letter is to suggest NET as a safe low toxicity treatment strategy for breast cancer, not only to postpone breast cancer surgery during the pandemic, but also to become a standard therapy, a flame kept burning crossing the COVID-19 border.

This study aimed to assess the accuracy of ultrasound-guided fine needle aspiration cytology (US-FNAC) to detect axillary involvement in breast cancer and to compare with other methods of axilla assessment: axillary palpation (AP) and isolated axillary ultrasound (A-US). Methods: A retrospective accuracy study was performed using data from medical records of patients assisted at a breast cancer service in Recife, Brazil, between 2013 and 2017. A histopathological result (sentinel lymph node and/or axillary dissection) was adopted as a gold standard. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the AP, the A-US and US-FNAC were calculated. Results: 206 tumors were analyzed. The AP was truly positive in 34.0% of the results similar values were obtained for A-US (36.4%). The lowest incidence of false negative was in the US-FNAC (16.5%). Axillary involvement was identified in 82 (39.8%) cases. The US-FNAC was performed in 79 cases, 51 (64.5%) were identified as true positive and 13 (16.5%) were false negative. When analyzing the comparative results of AP, A-US and the US-FNAC of the axilla with histopathology, it was observed that AP presented an accuracy of 69.9% (95%CI=63.1-76.1), better than the A-US, which its accuracy was 68% (95%CI=61.1-74.3). The US-FNAC showed high specificity (100%, 95%CI=81.9-100%), of PPV at 100% (95%CI=94.3-100%), but with a low NPV (53.6%, 95%CI=33.9-72.5). The best NPV was the AP (59.7%, 95%CI=50.5-68.4). The US-FNAC accuracy was 83.5% (95%CI=73.5-91.0). Conclusion: The good accuracy associated to the high specificity and the PPV of the US-FNAC suggests it to be a promising examination in the diagnosis of axillary involvement in breast cancer and an ally to better define therapeutic conducts.

Introduction: Ultrasound-guided fine needle aspiration cytology (US-FNAC) in breast cancer has been suggested as a cost-effective exam and of quick performance to detect axillary involvement. However, the efficacy of ultrasound-guided biopsy can vary in distinct centers because the accuracy of ultrasound examination is operator- dependent. Objective: To report the accuracy of US-FNAC to detect axillary involvement in breast cancer and to compare with other methods of axilla assessment: Axillary palpation (AP) and isolated axillary ultrasound (A-US) in our institution. Method: An accuracy study was carried out, using data of breast cancer patients assisted at a mastology service, between 2013 and 2017 in Recife, Brazil. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the AP, the A-US and US-FNAC. A histopathological result (sentinel lymph node and/or axillary dissection) was adopted as a gold standard. This study was approved by the Research Ethics Committee of the institution. Results: 206 tumors were analyzed. The US-FNAC was performed in 142 (49.5%) cases and positive for malignancy in 74 (25.6%). AP presented the lowest sensitivity (58.3%, 95%CI 49-67.3), however, with an accuracy of 69.9%, better than the A-US, whose accuracy was 68%. The US-FNAC showed high specificity (100%) with PPV of 100%, but with low NPV (53.6%). The best NPV was AP (59.7%), followed by A-US (59.1%). The US-FNAC accuracy was 83.5%. Table - Sensitivity, specificity, accuracy and predictive values of the AP, A-US and US-FNAC with a gold standard (histopathology) in the diagnosis of axillary involvement in breast cancer in women assisted at the mastology service at IMIP, Recife, Brazil, 2013- 2017. ExamSensitivity % (95% CI)Specificity % (95% CI)Accuracy % (95% CI)PPV % (95% CI)NPV % (95% CI)AP (n=206)58.3 (49.0-67.3)86.0 (76.9-92.6)69.9 (63.1-76.1)85.4 (75.9-92.2)59.7 (50.5-68.4)A-US (n=206)62.5 (53.2-71.2)75.6 (65.1-84.2)68.0 (61.1-74.3)78.1 (68.5-85.9)59.1 (49.3-68.4)US-FNAC (n=79)79.7 (67.8-88.7)100.0 (81.9-100.0)83.5 (73.5-91.0)100.0 (94.3-100.0)53.6 (33.9-72.5) AP = axillary palpation, A-US=axillary ultrasound, US-FNAC= ultrasound-guided fine needle aspiration cytology, PPV=positive predictive value, NPV=negative predictive value. Conclusion: The good accuracy associated to the high specificity and the PPV of the US-FNAC suggests US-FNAC to be a good exam in the diagnosis of axillary involvement in breast cancer and an ally to better define therapeutic management. Keywords: Breast Neoplasms; Biopsy, Fine-Needle; Neoadjuvant Therapy; Sentinel Lymph Node; Ultrasonography, Mammary. Citation Format: Maria Carolina Gouveia, Candice Lima Santos, Isabel Cristina Pereira, Jose Natal Figueiroa, Ariani Impieri Souza. Accuracy of ultrasound-guided fine needle aspiration citology (US-FNAC) to detect axillary involvement in breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-02-15.