Axillary ultrasound and fine-needle aspiration in preoperative staging of axillary lymph nodes in patients with invasive breast cancer

Rocha, Rafael Dahmer; Girardi, André Ricardo; Pinto, Renata Reis; Freitas, Viviane Aguilera Rolim de

doi:10.1590/0100-3984.2014.0121

Cited by 32 publications

(23 citation statements)

References 33 publications

(48 reference statements)

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“…The results of this study confirm, with a positive predictive value of 99.6%, the clinical utility of FNAC to direct treatment when the patient has a positive C5 FNAC. Other studies report a similarly low false‐positive rate of FNAC (0%‐1.6%) . Potential explanations for false‐positive FNACs include cytologic misinterpretation (eg, misreading myoepithelial cells or lymphocytes as breast epithelial cells) or inadequate sampling of the lymph nodes at the time of surgical dissection .…”

Section: Discussionsupporting

confidence: 66%

“…In patients with axillary nodal metastases confirmed on FNAC, the management options are axillary nodal clearance or neo‐adjuvant therapy to downstage disease prior to definitive surgery . FNAC has been shown to avoid an unnecessary SLNB in up to 50% of cases and may reduce healthcare costs . The results of this study confirm, with a positive predictive value of 99.6%, the clinical utility of FNAC to direct treatment when the patient has a positive C5 FNAC.…”

Section: Discussionmentioning

confidence: 97%

“…FNAC has been shown to avoid an unnecessary SLNB in up to 50% of cases and may reduce healthcare costs. 6,[9][10][11]22,25,26 The results of this study confirm, with a positive predictive value of 99.6%, the clinical utility of FNAC to direct treatment when the patient has a positive C5 FNAC. Other studies report a similarly low false-positive rate of FNAC (0%-1.6%).…”

Section: Discussionmentioning

confidence: 99%

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False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients

et al. 2019

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Axillary nodal status remains an important determinant of prognosis and of the therapeutic strategy in patients with a newly diagnosed breast cancer. The aim of this study was to assess the false‐negative rate of ultrasound (US)‐guided fine‐needle aspiration cytology (FNAC) in axillary node staging at breast cancer diagnosis. All patients with a newly diagnosed breast cancer who had an indeterminate or suspicious axillary node sampled with an FNAC between 2007 and 2014 were included in the study. FNAC results were compared to the final histopathological results of surgically removed axillary lymph nodes. Patient demographics, tumor, and nodal characteristics were analyzed. Diagnostic accuracy tests were performed using IBM SPSS, version 22. A total of 3515 patients with breast cancer were identified, 675 of whom had ultrasound‐guided FNAC of ipsilateral axillary lymph nodes (mean age: 55 years; Range: 26‐84). A benign (C2) result was observed in 52% (n = 351) and a malignant (C5) result in 35% (n = 238). C1 was obtained in 11% (n = 76), C3 in 0.6% (n = 4), and C4 in 0.9% (n = 6). Of the 238 patients with a malignant (C5) FNAC, 99.6% had confirmed axillary lymph node metastatic disease on histopathology. Of the 351 patients with benign FNAC (C2), 31% (n = 108) of patients had a positive lymph node on histology. The false‐negative rate of preoperative FNAC remains too high (31%) to omit definitive surgical staging of the axilla. The high diagnostic accuracy when a positive FNAC is obtained allows appropriate tailored decisions regarding definitive therapy.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients

et al. 2019

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“…In patients with clinically positive nodes, to determine whether ALND is needed, the panel recommends pathologic confirmation of malignancy using ultrasound-guided fine-needle aspiration (FNA) 14 or core biopsy of suspicious nodes. According to the NCCN panel, the recommendation for axillary dissection of level I and II nodes is limited to patients with biopsy-proven axillary metastases.…”

Section: Nccn Recommendationsmentioning

confidence: 99%

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

Gradishar¹,

Anderson

Balassanian

et al. 2017

J Natl Compr Canc Netw

396

346

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These NCCN Guidelines Insights highlight the important updates/changes to the surgical axillary staging, radiation therapy, and systemic therapy recommendations for hormone receptor-positive disease in the 1.2017 version of the NCCN Guidelines for Breast Cancer. This report summarizes these updates and discusses the rationale behind them. Updates on new drug approvals, not available at press time, can be found in the most recent version of these guidelines at NCCN.org.

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“…Lymph node biopsy may be performed using FNAC or CB [1]. The addition of US -FNAC in cases of suspicious for malignancy may prevent more than 50% of sentinel lymphadenectomies, significantly shortening the time interval to definitive surgery [2].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of ultrasound scan guided needle biopsy in preoperative diagnosis of metastatic axillary lymphadenopathy in patients with breast cancer

El-Gammal¹,

Ng²,

Kumar³

et al. 2017

Breast Cancer Rep

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Background: Pre-operative diagnosis of axillary node status is important in the management of patients with breast cancer. Ultrasound scanning (US) is an essential part of triple assessment of these patients with biopsy by either fine needle aspiration cytology (FNAC) and/or core biopsy (CB) of suspicious lymph nodes. The aim of this study is to establish the accuracy of preoperative US scan with US guided needle biopsy (USB) of suspicious nodes in the diagnosis of metastatic disease. Compliance with the current recommendations of the Royal College of Radiologists (RCR) was audited. Material and methods: A retrospective analysis of all patients diagnosed with invasive breast cancer from April 2015 till March 2016 who underwent preoperative US axillary assessment followed by axillary surgery. Preoperative ultrasounds and US guided FNAC or CB of axillary lymph nodes were correlated with final histology of sentinel lymph node biopsy (SLN) or axillary lymph node clearance (ALND). Patients with micro-metastasis were excluded from this analysis. Findings or results: 292 patients were identified (163 symptomatic invasive breast cancers and 129 screen detected). Following axillary surgery 95 /292 (32.5%) patients had nodal metastatic involvement on final histology. 68/163 (41.7%) of the symptomatic group had proven metastatic disease on final histology whereas only 27/129 (20.9%) of the screen detected group had metastatic disease. The sensitivity of US alone diagnosis in the symptomatic group was 73.5% and US guided sampling was 76% whereas in the screening group the sensitivity of ultrasound was 44.4% and ultrasound biopsy83% respectively. Conclusions: Our results better the Royal College of Radiology guidelines (target of 50% or above) for both US assessment and US guided biopsy for symptomatic group. The screening group results were lower than the symptomatic group which probably is a reflection of a lower metastatic burden.

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Axillary ultrasound and fine-needle aspiration in preoperative staging of axillary lymph nodes in patients with invasive breast cancer

Cited by 32 publications

References 33 publications

False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients

False‐negative rate of ultrasound‐guided fine‐needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients

NCCN Guidelines Insights: Breast Cancer, Version 1.2017

Accuracy of ultrasound scan guided needle biopsy in preoperative diagnosis of metastatic axillary lymphadenopathy in patients with breast cancer

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