Axillary Lymph Node Biopsy in Newly Diagnosed Invasive Breast Cancer: Comparative Accuracy of Fine-Needle Aspiration Biopsy versus Core-Needle Biopsy

Rautiainen, Suvi; Masarwah, Amro; Sudah, Mazen; Sutela, Anna; Pelkonen, Outi; Joukainen, Sarianna; Sironen, Reijo; Kärjä, Vesa; Vanninen, Ritva

doi:10.1148/radiol.13122637

Cited by 96 publications

(74 citation statements)

References 41 publications

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“…Both FNA and core biopsy have been described [14, 28]. Core biopsy obtains a better tissue sample, but the presence of large vessels and delicate nerve plexus increases the risk for complications [28]. Rautiainen et al [28] recommend routine use of core biopsy over FNA and considered it a safe procedure.…”

Section: Discussionmentioning

confidence: 99%

The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

Vijayaraghavan

Vedantham

Kataoka³

et al. 2017

Academic Radiology

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Rationale and Objective Evaluation of nodal involvement in early-stage breast cancers (T1 or T2) changed following the Z11 trial; however, not all patients meet the Z11 inclusion criteria. Hence, the relevance of ultrasound imaging of the axilla and fine-needle aspiration biopsy (FNA) in early-stage breast cancers was investigated. Materials and Methods In this single-center, retrospective study, 758 subjects had pathology-verified breast cancer diagnosis over a 3-year period, of which 128 subjects with T1/T2 breast tumors had abnormal axillary lymph nodes on ultrasound, had FNA, and proceeded to axillary surgery. Ultrasound images were reviewed and analyzed using multivariable logistic regression to identify the features predictive of positive FNA. Accuracy of FNA was quantified as the area under the receiver operating characteristic curve with axillary surgery as reference standard. Results Of 128 subjects, 61 and 65 were positive on FNA and axillary surgery, respectively. Sensitivity, specificity, positive- and negative-predictive values of FNA were 52/65 (80%), 54/63 (85.7%), 52/61(85.2%) and 54/67 (80.5%), respectively. After adjusting for neoadjuvant chemotherapy between FNA and surgery, a positive FNA was associated with higher likelihood for positive axillary surgery (odds ratio: 22.7; 95% CI: 7.2–71.3, p<0.0001), and the accuracy of FNA was 0.801 (95% CI: 0.727–0.876). Among ultrasound imaging features, cortical thickness and abnormal hilum were predictive (p<0.017) of positive FNA with accuracy of 0.817 (95% CI: 0.741–0.893). Conclusion Ultrasound imaging and FNA can play an important role in the management of early breast cancers even in the post-Z11 era. Higher weightage can be accorded to cortical thickness and hilum during ultrasound evaluation.

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Section: Discussionmentioning

confidence: 99%

The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

Vijayaraghavan

Vedantham

Kataoka³

et al. 2017

Academic Radiology

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“…Fine needle aspiration (FNA) or core needle biopsy, guided by ultrasound, should be performed on any suspicious appearing lymph nodes, although core needle biopsy is preferred when feasible due to greater accuracy. 13 …”

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confidence: 99%

Imaging Considerations and Interprofessional Opportunities in the Care of Breast Cancer Patients in the Neoadjuvant Setting

Sorace¹,

Harvey²,

Syed³

et al. 2017

Seminars in Oncology Nursing

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Objective To discuss standard-of-care and emerging imaging techniques employed for screening and detection, diagnosis and staging, monitoring response to therapy, and guiding cancer treatments. Data Sources Published journal articles indexed in the National Library of Medicine database and relevant websites. Conclusion Imaging plays a fundamental role in the care of cancer patients and specifically, breast cancer patients in the neoadjuvant setting, providing an excellent opportunity for interprofessional collaboration between oncologists, researchers, radiologists and oncology nurses. Quantitative imaging strategies to assess cellular, molecular, and vascular characteristics within the tumor is needed to better evaluate initial diagnosis and treatment response. Implications for nursing practice Nurses caring for patients in all settings must continue to seek education on emerging imaging techniques. Oncology nurses provide education about the test, ensure the patient has appropriate pre testing instructions, and manage patient expectations about timing of results availability.

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“…Table 4 summarizes the advantages of the combined procedure. Therefore, and as shown by other investigators, the utilization of both aspirate smears and core tissue biopsy material are complementary and have added value compared to either one alone [7,13,26,29,33,35,38,39,44,45,46,47,50,51,52,57,58,59,60,61,62,68,75,76,77,78]. …”

Section: Advantages Of the Combined Approachmentioning

confidence: 86%

“…Although it is well known when evaluating mammary carcinoma that the axillary node status is best tackled by aspirate smears, FNAB alone in many cases cannot confirm that. Moreover, FNAB alone cannot confirm the presence of tumor invasion and cannot be used to differentiate between invasive and in situ neoplasia [29,30,31]. In addition, low-grade breast lesions, such as atypical ductal hyperplasia, low-grade ductal carcinoma in situ and tubular carcinoma, cannot be accurately diagnosed using this modality alone [32,33,34,35].…”

Section: Limitations Of Fnabmentioning

confidence: 99%

Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach

Joudeh¹,

Shareef²,

Al‐Abbadi³

2016

Acta Cytologica

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Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach.

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Axillary Lymph Node Biopsy in Newly Diagnosed Invasive Breast Cancer: Comparative Accuracy of Fine-Needle Aspiration Biopsy versus Core-Needle Biopsy

Abstract: When accurate preoperative staging of the axilla is needed in patients with newly diagnosed invasive breast cancer, CNB is more sensitive than FNAB.

Cited by 96 publications

References 41 publications

The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

The Relevance of Ultrasound Imaging of Suspicious Axillary Lymph Nodes and Fine-needle Aspiration Biopsy in the Post-ACOSOG Z11 Era in Early Breast Cancer

Imaging Considerations and Interprofessional Opportunities in the Care of Breast Cancer Patients in the Neoadjuvant Setting

Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach

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