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

Abstract

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.

Diagnostic Accuracy of Fine-Needle Aspiration Cytology and Core-Needle Biopsy in the Assessment of the Axillary Lymph Nodes in Breast Cancer—A Meta-Analysis

“…Thus, ALNs with isolated tumor cells or micrometastasis have no significant impact on the diagnostic accuracy of preoperative US-FNAC/CNB. As per the report of Kane et al [ 34 ], macrometastasis and micrometastasis in the false-negative cases of FNAC were 69% and 31%, respectively. In a previous study, the false-negative rate was significantly correlated with the size of the suspicious ALNs [ 82 ].…”

“…After AUS and US-FNAC, core needle biopsy (CNB) is recommended as the preoperative assessment. In daily practice, various methods are introduced for cytological preparation, such as conventional smear (CS), liquid-based preparation (LBP) and cell block [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , <...>…”

False‐negative ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer patients

“…The reported false-negative rate of FNAC ranges from 13% to 39%, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] although the results vary depending on the inclusion criteria. The common causes of false-negative FNAC cases include small-sized metastases.…”

“…Importantly, LNs should be carefully selected to reduce false-negative FNAC results.Conversely, 37% (19/52) had ≥3 metastatic LNs in the present study. The percentage of patients with ≥3 positive LNs has been reported to range from 19% to 43% in patients with false-negative FNAC results [19][20][21]. Considering the false-negative rate of FNAC and the high proportion of patients with ≥3 positive LNs, these results suggest that SLNB cannot be omitted in patients with negative FNAC.…”

Lymphadenopathy in a tuberculosis-endemic area: Diagnostic pitfalls and suggested approach

“…Even in a perioperative setting of patients undergoing surgery for breast cancer, the false-negative rate of FNA of axillary lymph nodes (under ultrasound guidance) has been shown to be too high (30%) to replace excision biopsy. [20] Due to the low negative predictive value of the FNAC from a lymph node, especially in lymphoma, the test may be useful where disseminated malignancy is highly suspected, but it should not be employed as a 'rule-out' test for either lymphoma or malignancy.…”