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

Cardoso‐Coelho, Lívio Portela; Borges, Rafael Soares; Alencar, Airlane Pereira; Cardoso‐Campos‐Verdes, Larysse Maira; Silva‐Sampaio, João Paulo da; Borges, Umbelina Soares; Gebrim, Luíz Henrique; Silva, Benedito Borges da

doi:10.3892/ol.2017.5817

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…However, considering the definite operative histology as a reference, the second-look AUS and FNAB revealed false-negative results in 30.7% and 52.2% of our cases, respectively. Hence, AUS-guided FNAB was associated a PPV of 96.12% but an NPV of 47.83%, supporting the previously reported low NPV (ranged 59.3% to 73.0%) and high false negativity (ranged 19.4% to 31.8%) of this method in detecting ALN metastases [ 10 , 11 , 13 , 17 , 20 , 27 , 28 ]. Given that the negative AUS-FNAB revealed nonmetastatic axillae only in half of our patients, our findings seem to support that AUS-FNAB alone is not likely to be relied upon in axillary investigation to replace SLNB for the time being due to moderate sensitivity and the high false-negative rate [ 17 , 20 ].…”

Section: Discussionsupporting

confidence: 83%

“…Notably, in a past study with 27 early-stage breast cancer patients, FNAB in comparison with SLNB was reported to have a sensitivity, specificity, PPV and NPV of 45%, 100%, 100%, and 73%, respectively [ 13 ]. The authors concluded the similar specificity of FNAB-based and SLNB-based ALN cytology in the presence of ALN metastases, whereas lower sensitivity of FNAB than SLNB when lymph node cytology is negative, indicating that negative AUS-FNAB results do not rule out the metastatic implants [ 13 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the context of alternative methods to replace SLNB with a decreasing role for axillary node dissection, US-guided FNAB has become a promising minimally invasive method in the accurate staging of the axilla with the preoperative detection of nodal metastasis, while a need for larger-scale and longer–follow-up comparative studies has been emphasized [ 13 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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The validity and clinical utility of axillary ultrasonography-guided fine needle aspiration biopsy in detection of nodal metastasis in early-stage breast cancer patients: a retrospective single-center experience

TAŞÇI¹,

METİN²,

METİN³

et al. 2022

Turkish Journal of Medical Sciences

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Background/aim Assessing the validity and clinical utility of axillary ultrasonography (AUS)-guided fine needle aspiration biopsy (FNAB) in detection of nodal metastasis during preoperative axillary investigation in comparison to the histopathologic diagnosis in early-stage breast cancer. Materials and methods A total of 279 operated primary breast cancer patients (age: 55.3 ± 12.8, ranged 17–90 years) were included. Data on AUS findings at the time of initial diagnosis (first look AUS), second-look AUS findings performed by the breast radiologist during breast biopsy procedure and the AUS-guided FNAB findings were evaluated with respect to the final histopathology report obtained through axillary surgery via sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND). The diagnostic performance of each method in detecting metastatic ALNs were compared in terms of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results The sensitivity, specificity, and accuracy of the first look AUS in detecting nodal metastasis were 64.56%, 86.78%, and 74.19% while the PPV and NPV were 86.44% and 65.22%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS were 70.25%, 87.60%, and 77.78%, while PPV and NPV were 88.10% and 69.28%, respectively. The sensitivity, specificity, and accuracy of the second-look AUS guided FNAB were 89.19%, 73.33%, and 87.30%, while the PPV and NPV were 96.12% and 47.83%, respectively. The consideration of second-look AUS and finding of nodal metastasis in FNAB was associated with significantly higher likelihood of ALND (55.4% vs. 44.6%, p < 0.001) and lower likelihood of SLNB (34.7% vs. 65.3%, p < 0.001) compared to consideration of nonmetastatic ALN status. In 23 (22.3%) patients with positive findings on AUS-guided FNAB, SLNB was applied; 21 had positive results after surgical dissection, indicating that nearly 20% of patients had unnecessary SLNB. Conclusion US-guided FNAB of suspicious ALNs is a simple, minimally invasive, and highly effective method for preoperative axillary staging in patients with invasive breast cancer avoiding the more invasive method SLNB and it enables the surgeon to proceed directly to ALND in positive cases.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The validity and clinical utility of axillary ultrasonography-guided fine needle aspiration biopsy in detection of nodal metastasis in early-stage breast cancer patients: a retrospective single-center experience

TAŞÇI¹,

METİN²,

METİN³

et al. 2022

Turkish Journal of Medical Sciences

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“…In the current clinical practice, conventional US-guided FNAB is a common method to diagnose ALN before surgery [29]. However, the moderate sensitivity of conventional US may lead to a relatively high FNR [30,31]. A previous study has shown that the sensitivity and FNR of US-guided FNAB for detecting metastatic ALNs in early breast cancer were 45% and 55%, respectively [32].…”

Section: Discussionmentioning

confidence: 99%

The value of quantitative shear wave elastography combined with conventional ultrasound in evaluating and guiding fine needle aspiration biopsy of axillary lymph node for early breast cancer: implication for axillary surgical stage

Liu,

Huang,

et al. 2024

Preprint

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Objectives To investigate the value of conventional ultrasonography (US) combined with quantitative shear wave elastography (SWE) in evaluating and identifying target axillary lymph node (TALN) for fine needle aspiration biopsy (FNAB) of early breast cancer patients. Materials and methods A total of 222 patients with 223 ALNs were prospectively recruited from January 2018 to December 2021. All TALNs were evaluated by US, SWE and subsequently underwent FNAB. The diagnostic performances of US, SWE, two combination methods of US and SWE (“US or SWE” and “US and SWE”), and FNAB guided by the above four methods for evaluating ALN status were assessed using receiver operator characteristic curve analyses. Univariate and multivariate logistic regression analyses used to determine the independent predictors of axillary burden. Results The area under the ROC curve (AUC) for the ability of conventional US and SWE in diagnosing ALNs were 0.70 and 0.66, with a sensitivity of 78.00% and 65.00%, a specificity of 60.98% and 66.67%. Using the SWE to combined with US, the “US or SWE” achieved significantly improved sensitivity of 86.00%. The AUC of the “US or SWE”-guided FNAB [0.85 (95% CI, 0.80–0.90)] was significantly higher than that of US-guided FNAB [0.83 (95% CI, 0.78–0.88), p = 0.042], SWE-guided FNAB [0.79 (95% CI, 0.73–0.84), p = 0.001], and US and SWE-guided FNAB [0.77 (95% CI, 0.71–0.82), p < 0.001]. Multivariate logistic regression showed that FNAB and number of suspicious ALNs were found independent predictors of axillary burden in early breast cancer patients. Conclusion The "US or SWE" had superior sensitivity compared to US or SWE alone in ALN diagnosis. The "US or SWE"-guided FNAB achieved a lower false-negative rate compared to FNAB guided solely by US or SWE, which may be a promising tool for the preoperative diagnosis of ALNs in early breast cancer, and had the potential implication for the selection of axillary surgical modality.

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“…This increases the likelihood of a positive FNAC considerably and explains some of the higher reported sensitivity rates, and might explain our sensitivity rate since we performed FNAC regardless of suspicion of metastasis on US examination. Nonetheless, low sensitivity and moderate negative predictive values remain an issue [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Gamma probe and ultrasound-guided fine needle aspiration cytology of the sentinel node (GULF) trial

Verver

Ophuis

Koppert

et al. 2018

Eur J Nucl Med Mol Imaging

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PurposeSentinel lymph node biopsy (SLNB) was introduced as a minimally invasive technique for nodal staging. Since associated morbidity is not negligible, it is highly relevant to pursue a more minimally invasive alternative. The purpose of this study was to prospectively evaluate the sensitivity of fine needle aspiration cytology (FNAC) with combined gamma probe and ultrasound (US) guidance in comparison with the gold standard histology of the sentinel node (SN) after SLNB for detecting metastasis.MethodsThe study was designed as a prospective, multicentre, open-label, single-arm trial enrolling patients with newly diagnosed cutaneous melanoma or breast cancer between May 2015 and August 2017. Sample radioactivity was measured using a Mini 900 scintillation monitor. After FNAC, all patients underwent SLNB. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated.ResultsAccrual was terminated early following an unplanned interim analysis indicating that a FNAC sensitivity of at least 80% could not be achieved. In total 58 patients of the originally planned 116 patients underwent FNAC with gamma probe and US guidance. There were no true-positive FNAC results, 14 false-negative results and one false-positive result, and thus the sensitivity, specificity, PPV and NPV of FNAC were 0%, 98%, 0% and 75%, respectively. At least 75% of the FNAC samples had a radioactivity signal higher than the background signal.ConclusionFNAC with gamma probe and US guidance is not able to correctly detect metastases in the SN and is therefore not able to replace SLNB. Gamma probe-guided US is a highly accurate method for correctly identifying the SN, which offers possibilities for future research.Electronic supplementary materialThe online version of this article (10.1007/s00259-018-4014-3) contains supplementary material, which is available to authorized users.

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

Cited by 6 publications

References 27 publications

The validity and clinical utility of axillary ultrasonography-guided fine needle aspiration biopsy in detection of nodal metastasis in early-stage breast cancer patients: a retrospective single-center experience

The validity and clinical utility of axillary ultrasonography-guided fine needle aspiration biopsy in detection of nodal metastasis in early-stage breast cancer patients: a retrospective single-center experience

The value of quantitative shear wave elastography combined with conventional ultrasound in evaluating and guiding fine needle aspiration biopsy of axillary lymph node for early breast cancer: implication for axillary surgical stage

Gamma probe and ultrasound-guided fine needle aspiration cytology of the sentinel node (GULF) trial

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