A Positive Node on Ultrasound‐Guided Fine Needle Aspiration Predicts Higher Nodal Burden Than a Positive Sentinel Lymph Node Biopsy in Breast Carcinoma

Boland, Michael R.; Cearbhaill, R. Ni; Fitzpatrick, Kimberly A.; Walsh, Siún; Evoy, Denis; Geraghty, James; Rothwell, Jane; McNally, Sorcha; O’Doherty, Ann; Quinn, Cecily; McDermott, Enda; Prichard, Ruth

doi:10.1007/s00268-016-3557-3

Cited by 19 publications

(29 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in our series of 72 patients with nonpalpable axillary nodes, positive FNAC, T1‐2 primary tumor and breast‐conserving surgery, 22 (31%) showed less than three metastatic axillary nodes, therefore fitting with ACOSOG Z0011 criteria and would have avoided axillary dissection . Other studies have found similar results …”

Section: Discussionsupporting

confidence: 67%

“…Boland et al found that the FNAC‐positive patients, compared to the positive SLNB group, are more likely to undergo mastectomy (53.8% vs 35.5%, P < .001). In the FNAC‐positive group more aggressive tumor characteristics were found: a higher median tumor grade (3 vs 2; P < .001) and a higher frequency of Her‐2/neu amplification (25% vs 12.6%; P < .001) . Verheuvel et al published similar results with a higher proportion of mastectomies in FNAC‐positive patients than in SLNB‐positive group (64.7% vs 31.3%, P < .001), because of larger tumors (≥ 20 mm 83% vs 41.8%, P < .001), with worse prognostic factors: high tumor grade (G3 27% vs 18%, P < .001) and Her‐2/neu amplification (18.7% vs 8%, P < .006).…”

Section: Discussionmentioning

confidence: 78%

“…In the study of Boland, the number of metastatic lymph nodes was 3 in FNAC‐positive patients vs 1 in SLNB‐positive patients; in the studies of Verheuvel and Van Wely were, respectively, 4 and 1. In the paper of Bortolini, more than 50% of the 239 FNAC‐positive patients had pN2a/pN3a disease, compared with only 18% of SLNB‐positive patients.…”

Section: Discussionmentioning

confidence: 92%

“…This may look like a paradox, as stated by N. C. Verheuvel in a recent paper: “the better the radiologist (or imaging procedure) can identify axillary metastases, the worse the surgical consequences for the patient.”…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Axillary dissection in patients with preoperative positive nodal cytology: Genuine need or overtreatment?

et al. 2019

View full text Add to dashboard Cite

Recent studies demonstrated the possibility to avoid axillary dissection (ALND) in selected patients with one or two metastatic nodes. Otherwise, patients with positive nodal ultrasound‐guided fine‐needle aspiration cytology (US‐FNAC) currently undergo ALDN. The aim of this study is to quantify the nodal burden in patients with positive US‐FNAC treated with ALND and to evaluate if clinical or pathological characteristics associated with low nodal involvement can be identified. This is a multicentric retrospective study involving 297 patients who underwent ALND because of a positive preoperative US‐FNAC. A total of 157 patients showed bulky axillary lymph nodes at diagnosis, and 70% of them had three or more metastatic nodes. One hundred and forty patients had a clinically negative axilla and in 50% of them, 4 or more metastatic nodes were found with axillary dissection. Overall, the median number of metastatic nodes was 5. Favorable pathological characteristics of tumors were found in patients with only one or two metastatic nodes: smaller primary tumor, a lower proportion of grade 3, invasive lobular carcinomas and a higher proportion of low‐Ki67 tumors. In the group of patients with clinically negative axilla and potentially meeting ACOSOG Z0011 criteria, 22 (31%) showed less than three metastatic axillary nodes. A preoperative positive axillary FNAC is associated with a metastatic nodal burden significantly higher than in patients with positive sentinel lymph node biopsy (SLNB). Nevertheless, about 30% of patients with cN0 axilla, positive axillary FNAC performed because of suspicious nodes on imaging, T1‐2 primary tumor and breast‐conserving surgery showed less than three metastatic axillary nodes, thus meeting ACOSOG Z0011 trial's criteria and therefore would be eligible for skipping ALND according to current guidelines.

show abstract

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Axillary dissection in patients with preoperative positive nodal cytology: Genuine need or overtreatment?

et al. 2019

View full text Add to dashboard Cite

show abstract

“…21 Pilewskie et al showed that positive FNAC was insufficient to warrant AD because 47% had only 1 to 2 metastatic LNs. Previous studies also showed that FNAC-positive patients had more aggressive clinicopathological characteristics and higher nodal burden than SLNB-positive patients, with the median number of involved LNs being 3 in FNAC-positive patients vs 1 in SLNB-positive patients.…”

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

View full text Add to dashboard Cite

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.

show abstract

Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis

Balasubramanian

Fleming

Corrigan

et al. 2018

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

A Positive Node on Ultrasound‐Guided Fine Needle Aspiration Predicts Higher Nodal Burden Than a Positive Sentinel Lymph Node Biopsy in Breast Carcinoma

Cited by 19 publications

References 36 publications

Axillary dissection in patients with preoperative positive nodal cytology: Genuine need or overtreatment?

Axillary dissection in patients with preoperative positive nodal cytology: Genuine need or overtreatment?

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

Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis

Contact Info

Product

Resources

About