Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer

Kanter, A.Y. de; Eijck, Casper H.J. van; Geel, A.N. van; Kruijt, R. H.; Henzen, S. C.; Paul, Marinus A.; Eggermont, Alexander M.M.; Wiggers, Theo

doi:10.1046/j.1365-2168.1999.01243.x

Cited by 189 publications

(175 citation statements)

References 16 publications

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“…We here reported a 16% false negative rate by US alone, since 28 out of 172 of US-nonsuspect LN were positive at histology. However, a great improvement of the diagnostic accuracy emerged when US examination was combined with FNAC of LN suspect to be metastatic, as demonstrated by the few available reports on the subject (Bonnema et al, 1997;Verbanck et al, 1997;de Kanter et al, 1999de Kanter et al, , 2000. In fact, in our study and in previous ones that used a similar approach, the cytological diagnosis of metastases reached 100% specificity.…”

Section: Discussionsupporting

confidence: 53%

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Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

et al. 2003

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The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the diagnosis of LN metastases and subsequently in the treatment of patients with breast cancer. Axillary US was performed in 298 patients with diagnosed breast cancer (267 invasive carcinomas and 31 ductal carcinoma in situ DCIS), and in 95 patients it was followed by FNAC of US suspicious LN. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry (ICC) with a combination of anticytokeratin and anti-HMFG2 antibodies. Eighty-five FNAC were informative (49 LN were positive for metastases, 36 were negative). In 49 of 267 patients with invasive breast carcinoma (18%), a preoperative diagnosis of metastatic LN in the axilla could be confirmed. These patients could proceed directly to axillary dissection. In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN. Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination. Based on these data, US examination should be performed in all patients with breast cancer adding ICC-supported FNAC only on US-suspect LN. This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.

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Section: Discussionsupporting

confidence: 53%

“…There are very few reports of image-guided LN fine-needle aspiration cytology (FNAC) as a means of improving presurgical staging of the axilla in breast cancer patients (Bonnema et al, 1997;Verbanck et al, 1997;de Kanter et al, 1999).…”

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confidence: 99%

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

et al. 2003

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“…In order to increase the specificity of preoperative assessment of the axilla, a number of groups have performed US-guided FNA (Bonnema et al, 1997;Verbanck et al, 1997;De Kanter et al, 1999;Krishnamurthy et al, 2002). Bonnema and de Kanter used this technique to detect axillary metastases in patients with operable breast cancer and preoperatively identified 63% (39 of 62) and 36% (31 of 87) of node-positive patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The range of sensitivity and specificity quoted in the literature for these techniques is such that the clinical management of the axilla cannot be modified for individual patients based upon these test results. US-guided fine needle aspiration (FNA) has been able to identify 36 -63% of node-positive patients preoperatively (Bonnema et al, 1997;De Kanter et al, 1999). Image-guided core biopsy has a higher sensitivity than FNA for assessing breast lesions (Britton and McCann, 1999), and therefore it would be anticipated that a similar improvement in sensitivity would be observed in USguided core biopsy of the axilla.…”

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confidence: 99%

Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer

et al. 2003

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The purpose of this study was to examine the use of ultrasound (US)-guided core biopsy of axillary nodes in patients with operable breast cancer. The ipsilateral axillae of 187 patients with suspected primary operable breast cancer were scanned. Nodes were classified based on their shape and cortical morphology. Abnormal nodes underwent US-guided core biopsy/fine needle aspiration (FNA), and the results correlated with subsequent axillary surgery. The nodes were identified on US in 103 of 166 axillae of patients with confirmed invasive carcinoma. In total, 54 (52%) met the criteria for biopsy: 48 core biopsies (26 malignant, 20 benign node, two normal) and six FNA were performed. On subsequent definitive histological examination, 64 of 166 (39%) had axillary metastases. Of the 64 patients with involved nodes at surgery, preoperative US identified nodes in 46 patients (72%), of which 35 (55%) met the criteria for biopsy and 27 (42%) of these were diagnosed preoperatively by US-guided biopsy. In conclusion, US can identify abnormal nodes in patients presenting with primary operable breast cancer. In all, 65% of these nodes are malignant and this can often be confirmed with US-guided core biopsy.

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“…The accuracy of preoperative ultrasonographic diagnosis of nodal metastasis has improved with the development of high-frequency ultrasonography technology. Axillary ultrasonography is increasingly being used to improve the staging of breast cancer patients who have negative axillary lymph nodes on physical examination (Herrada et al, 1997;de Kanter et al, 1999). But due to overlapping sonographic features of benign/reactive and suspicious/ metastatic lymph nodes, the value of ultrasonography in the diagnosis of lymph nodes metastasiss had been discounted.…”

Section: Diagnostic Accuracy Of Ultrasonograph Guided Fine-needle Aspmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasonograph Guided Fine-needle Aspiration Cytologic in Staging of Axillary Lymph Node Metastasis in Breast Cancer Patients: a Meta-analysis

Wang

Xiong²,

Zen³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer

Abstract: In patients without palpable axillary nodes, a sentinel node biopsy could be avoided in 17 per cent since ultrasonography combined with FNAC had already diagnosed axillary metastases. The method is particularly valuable in larger breast cancers.

Cited by 189 publications

References 16 publications

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer

Diagnostic Accuracy of Ultrasonograph Guided Fine-needle Aspiration Cytologic in Staging of Axillary Lymph Node Metastasis in Breast Cancer Patients: a Meta-analysis

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