Axillary nodal burden in primary breast cancer patients with positive pre-operative ultrasound guided fine needle aspiration cytology: Management in the era of ACOSOG Z011

Boland, Michael R.; Prichard, Ruth; Daskalova, I; Lowery, Aoife; Evoy, Denis; Geraghty, James; Rothwell, Jane; Quinn, Cecily; O’Doherty, Ann; McDermott, Enda

doi:10.1016/j.ejso.2015.01.011

Cited by 45 publications

(35 citation statements)

References 21 publications

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“…In support of this are several studies indicating that identification of axillary lymph nodes prior to primary surgery may obviate the need for a second axillary surgical procedure in 17–20% of patients with its attendant morbidity [20, 22, 48, 49]. The finding of a significant nodal disease burden in the majority of patients with a positive FNAB also provides justification for this approach [3]. …”

Section: Resultsmentioning

confidence: 93%

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Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma

2019

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Context: Fine-needle aspiration biopsy (FNAB) is frequently used to stage the axilla preoperatively in patients with primary breast carcinoma. In the light of the ACOSOG-Z0011 and AMAROS trials that specified sentinel lymph node biopsy as an inclusion criterion, the role of FNAB in axillary staging is changing. Objective: This article will review the diagnostic accuracy of FNAB in staging of the axilla in patients with primary breast carcinoma. The efficacy of axillary FNAB compared with core-needle biopsy will be evaluated. The evolving approach to staging of the axilla, in the light of ACOSOG-Z0011 and AMAROS trials, will be discussed. Data Sources: Data were sourced from published peer-reviewed articles in PubMed (US National Library of Medicine) and published guidelines including the European Guidelines for Quality Assurance in Breast Cancer and those from the European Society of Medical Oncology (ESMO), Union for International Cancer (UICC), American Society of Clinical Oncology (ASCO), and the American Society of Breast Surgeons. Conclusions: FNAB of the axilla is almost 100% specific with a sensitivity between 40 and 90%. A positive FNAB reduces the need for a second axillary procedure by up to 20% with reduced morbidity and cost. The recent ACOSOG-Z0011 and AMAROS trials have reduced the use of FNAB axilla in American protocols, but it remains the standard of care in Europe.

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Section: Resultsmentioning

confidence: 93%

“…Staging of the axilla provides important prognostic information and guides surgical and systemic management in patients with primary breast cancer [1-3]. Full axillary lymph node dissection is associated with significant morbidity [4-8] and should be performed only when necessary [4, 9].…”

Section: Introductionmentioning

confidence: 99%

Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma

2019

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“…Axillary lymph node dissection may not be avoided in the majority of patients (94%), which is consistent with inclusion criteria of the ACOSOG Z011 trial. This may avoid sentinel lymph node mapping in these patients, who have a mean number of 4 lymph nodes involved, in addition to extracapsular disease (16).…”

Section: Discussionmentioning

confidence: 99%

“…However, SNB involves a complex laboratory technique, increasing surgical costs. In addition, clinical complications may arise, including anaphylactic reactions, lower sensitivity and strength of the ipsilateraley upper limb and even the rare occurrence of lymphedema (16,17).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Abstract. The replacement of sentinel lymph node biopsy (SNB) by ultrasound-guided fine-needle aspiration (US-guided FNA) cytology of axillary lymph nodes is controversial, despite the simplicity and reduced cost of the latter. In the present study, US-guided FNA was performed in 27 patients with early-stage breast cancer for comparison with SNB. Data were analyzed by calculation of sample proportions. Tumor subtypes included invasive ductal carcinoma (85%), invasive lobular carcinoma (7%), and tubular and metaplastic carcinoma (4%). FNA had a sensitivity of 45%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 73%. Axillary lymph node cytology obtained by US guided-FNA in patients with breast cancer had a specificity similar to that of sentinel lymph node histopathology in the presence of axillary node metastases. However, when lymph node cytology is negative, it does not exclude the existence of metastatic implants, due to its low sensitivity in comparison to sentinel lymph node histopathology.

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“…Although the FNR is not significantly different in patients with negative or positive findings on axillary US, it can identify patients with a likelihood of residual disease and higher burden of axillary disease [56]; hence, axillary US may improve the FNR according to partial data of the ACOSOG Z1071 trial [57].…”

Section: Surgical Lymph Node Stagingmentioning

confidence: 99%

Surgical Management of Breast Cancer Treated with Neoadjuvant Therapy

2018

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Axillary nodal burden in primary breast cancer patients with positive pre-operative ultrasound guided fine needle aspiration cytology: Management in the era of ACOSOG Z011

Cited by 45 publications

References 21 publications

Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma

Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma

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

Surgical Management of Breast Cancer Treated with Neoadjuvant Therapy

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