Current applications and future prospects of fine‐needle aspiration biopsy of locoregional lymph nodes in the management of breast cancer

Abstract

Staging of disease is routine in the evaluation of patients newly diagnosed with breast cancer. Assessment of palpable and/or nonpalpable locoregional lymph nodes is an important component of the initial staging.Ultrasound (US) is the favored imaging modality for the initial investigation of lymph nodes and results in a significant increase in the specificity of the overall evaluation when used in conjunction with fine-needle aspiration (FNA). This review provides a concise summary, based on published literature, of the current applications and future prospects of FNA biopsy of locoregional lymph nodes in the initial staging and subsequent surgical management of patients with breast cancer. Patients undergo either sentinel lymph node (SLN) biopsy or complete axillary lymph node dissection, based on whether the axillary lymph node status is determined to be negative or positive in the initial staging process. The status of lymph nodes in the supraclavicular, infraclavicular, and internal mammary regions provides more accurate staging information and also impacts subsequent surgical management. The identification and evaluation of intramammary lymph nodes can add value in the overall assessment of patients with breast cancer. The feasibility of noninvasive imaging modalities for SLN mapping in animal models has indicated a good potential for FNA biopsy in the subsequent investigation of SLNs identified noninvasively in humans. Staging of the malignant tumor is a routine component in the assessment of patients who are newly diagnosed with breast cancer. Breast cancer staging aids in the appropriate management of patients at each stage of disease and is useful in estimating the prognosis for a patient at a particular stage. The routine staging process includes taking a thorough history of the patient, physical examination, mammography, ultrasonography (US) of the breast and lymph node basins, computed tomography (CT) scan of the abdomen, bone scanning, and chest radiography. Cancer is assigned a clinical stage at the time of the initial diagnosis based on the findings of the physical examination, radiologic studies, and core needle biopsy (CNB) of the

Fine-Needle Aspiration Biopsy of the Lymph Node: A Novel Tool for the Monitoring of Immune Responses after Skin Antigen Delivery

“…One to two passages were used per sample. The LN sample was immediately transferred to medium-10% (v/v) human AB serum (PAA, Pasching, Austria) in RPMI 1640 medium (Life Technologies, Paisley, U.K.)-by "washing" the FNA needle several times with the medium (19) and transported to the laboratory at ambient temperature. The number of white cells in the LN sample was counted in a hemocytometer after staining with trypan blue (1:3 dilution in PBS) and 4% (v/v) acetic acid to eliminate RBC contamination.…”

“…For this purpose, we have used minimally invasive ultrasoundguided fine-needle aspiration (FNA) of the LN, a technique commonly used in clinical practice for cancer diagnosis (19). Axillary LN aspiration was used to sample the draining LN following PPD administered intradermally in the forearm.…”

Ultrasound-guided fine needle aspiration cytology in staging clinically node-negative invasive breast cancer

“…Seven (6.5%) out of 108 FNAC specimens were insufficient for diagnosis. Immediate assessment of specimens by a pathologist might reduce the proportion of inadequate samples [45] and allow additional lymph node passes by the radiologist to improve quality [28]. For the 86 patients treated by primary surgery, the overall sensitivity was 72.55% and the specificity was 100% (Table 6) although identifiable non-suspicious nodes were punctured and aspirated for cytological pretreatment examination.…”

“…Ultrasound (US) is a simple and well-accepted method to examine axillary and non-axillary lymph nodes associated with breast cancer. Recent publications have reported that routine axillary US combined with cytology or core biopsy is an effective method to evaluate lymph node metastases prior to surgery [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Thus, pretreatment axillary US for early breast cancer patients and needle sampling of morphologically abnormal lymph nodes are now widely recommended [36].…”

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

“…For almost a century, radical mastectomy plus axillary lymph node dissection, introduced by Halsted in 1882 until the 1970s of the 20th century (6), was the standard surgical treatment for all breast tumor stages, resulting in serious complications in the upper limb ipsilateral to surgery (7)(8)(9)(10)(11).…”