Efficiency of a Preoperative Axillary Ultrasound and Fine-Needle Aspiration Cytology to Detect Patients with Extensive Axillary Lymph Node Involvement

Castellano, Isabella; Deambrogio, Cristina; Muscarà, Francesca; Chiusa, Luigi; Mariscotti, Giovanna; Bussone, Riccardo; Gazzetta, Guglielmo; Macrì, Luigia; Cassoni, Paola; Sapino, Anna

doi:10.1371/journal.pone.0106640

Cited by 19 publications

(16 citation statements)

References 25 publications

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“…AFNA is a simple, inexpensive, and minimally invasive technique that makes possible reduction in the numbers of SN biopsies performed [19] [20]. Previous studies have reported that the sensitivity of AFNA was low and the false-negative rate was high [7] [10] [19] [20]. In this study, all patients with AFNA+ findings had metastatic disease at ALND.…”

Section: Discussionmentioning

confidence: 68%

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Usefulness of Breast MRI for Safe Omission of Axillary Lymph Nodes Dissection in Sentinel Node-Positive Breast Cancer Patients

Fuchikami¹,

Takeda²,

Sato³

2017

JCT

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Background: Preoperative identification of patients with extensive lymph node metastasis (LNM) is important for safe omission of axillary lymph node dissection (ALND) in sentinel node (SN)-positive (SN+) breast cancer patients. Methods: We evaluated retrospectively the collected data of 758 breast cancer patients who underwent axillary surgery between 2008 and 2017, excluding those who received neoadjuvant chemotherapy. Results: Of the 758 patients, 607 were not suspicious to have LNM by axillary ultrasound (AUS−), but 38 suspicious cases were found by breast magnetic resonance imaging (MRI). Of 15 patients undergoing axillary fine needle biopsy (AFNA) due to second-look axillary ultrasound (AUS), 9 underwent ALND because of a positive AFNA (AFNA+). Among 81 (10.9%) patients undergoing ALND due to SN+ findings, 6 (7.4%) had extensive LNM (LNM ≥ 4). If MRI was not performed, among the 90 of 673 patients undergoing ALND who had SN+ findings, 12 (13.3%) had LNM ≥ 4. Conclusions: The proportion of cases with LNM ≥ 4 was reduced from 13.3% to 7.4% among patients undergoing SN biopsies combined with breast MRI. ALND might be omitted safely in SN+ cases according to detailed preoperative evaluations using additional breast MRI to ultrasound.

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Section: Discussionmentioning

confidence: 68%

“…Although LNM ≥ 4 should be considered for RNI [7], propriety is unknown regarding ALND omission. The omission of ALND in surgical procedures for tumors with LNM has been considered, but remains controversial [8].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Breast MRI for Safe Omission of Axillary Lymph Nodes Dissection in Sentinel Node-Positive Breast Cancer Patients

Fuchikami¹,

Takeda²,

Sato³

2017

JCT

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“…This preference does not apply for sampling of lymph nodes suspected to be metastatic at ultrasound of axilla, where fine needle aspiration has been shown to be effective [34]. …”

Section: Preference For Core or Vacuum-assisted Biopsymentioning

confidence: 99%

Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey

et al. 2016

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EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50–69 years taking up the invitation while the probability of false-positive needle biopsy is <1 % per round and overdiagnosis is only 1–10 % for a 20-year screening. Mortality reduction was also observed for the age groups 40–49 years and 70–74 years, although with “limited evidence”. Thus, we firstly recommend biennial screening mammography for average-risk women aged 50–69 years; extension up to 73 or 75 years, biennially, is a second priority, from 40–45 to 49 years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become “routine mammography” in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged.Key points• EUSOBI and 30 national breast radiology bodies support screening mammography.• A first priority is double-reading biennial mammography for women aged 50–69 years.• Extension to 73–75 and from 40–45 to 49 years is also encouraged.• Digital mammography (not film-screen or computer radiography) should be used.• DBT is set to become “routine mammography” in the screening setting in the next future.

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“…Several studies have found AUS and USG-FNAC useful in the preoperative work-up of BC patients [9-11], but AUS characteristics such as lymph node size, cortical morphology, contour, and hilar fat were not individually predictive of final cytology and pathology [12]. …”

Section: Introductionmentioning

confidence: 99%

Correlation of Ultrasound Findings and Fine-Needle Aspiration Cytology for the Diagnosis of Axillary Lymph Node Metastasis in Patients with Breast Carcinoma

et al. 2018

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Objective: Ultrasound-guided fine-needle aspiration cytology (USG-FNAC) is used for the detection of axillary lymph node (ALN) metastasis in patients with breast carcinoma (BC). US findings have a good diagnostic accuracy with high sensitivity and specificity. The aim of this study is to correlate the detection of ALN metastases on US with FNAC in BC patients. Study Design: In 75 BC patients, over a period of 9 months (January to September 2017), the size, cortical thickness (CT), presence or absence of hilar fat, and length/width ratio of ALN on US were reviewed and correlated with FNAC findings. Results: The age range was 29–78 (mean 52) years. There were 38 patients with a single ALN and 37 with multiple ALNs. ALNs with a maximum length of > 2.5 cm were malignant in 100% of cases while those ≥1.5 cm were malignant in 80.4%. ALNs with a CT of > 3 mm had metastasis in 78.1% cases. ALNs with absent hilar fat showed tumour in 87.5% cases. A length/width ratio of < 2 showed a metastatic tumour in 66.7% of aspirates. Conclusion: An association was seen between metastatic carcinoma on FNAC and axillary US features of a maximum length of ≥1.5 cm, the absence of hilar fat, and a CT of > 3 mm (p < 0.05).

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Efficiency of a Preoperative Axillary Ultrasound and Fine-Needle Aspiration Cytology to Detect Patients with Extensive Axillary Lymph Node Involvement

Cited by 19 publications

References 25 publications

Usefulness of Breast MRI for Safe Omission of Axillary Lymph Nodes Dissection in Sentinel Node-Positive Breast Cancer Patients

Usefulness of Breast MRI for Safe Omission of Axillary Lymph Nodes Dissection in Sentinel Node-Positive Breast Cancer Patients

Correlation of Ultrasound Findings and Fine-Needle Aspiration Cytology for the Diagnosis of Axillary Lymph Node Metastasis in Patients with Breast Carcinoma

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