Preoperative Fine Needle Aspiration of Axillary Lymph Nodes in Breast Cancer: Clinical Utility, Diagnostic Accuracy and Potential Pitfalls

Gilani, Syed M.; Fathallah, Lamia; Al-Khafaji, Basim

doi:10.1159/000362682

Cited by 16 publications

(29 citation statements)

References 21 publications

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“…The results of this study confirm, with a positive predictive value of 99.6%, the clinical utility of FNAC to direct treatment when the patient has a positive C5 FNAC. Other studies report a similarly low false‐positive rate of FNAC (0%‐1.6%) . Potential explanations for false‐positive FNACs include cytologic misinterpretation (eg, misreading myoepithelial cells or lymphocytes as breast epithelial cells) or inadequate sampling of the lymph nodes at the time of surgical dissection .…”

Section: Discussionmentioning

confidence: 76%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 76%

“…Other studies report a similarly low false-positive rate of FNAC (0%-1.6%). 9,11,19,[26][27][28][29]…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…The characteristics of the patients are summarized in Table 1 Several studies showed the sensitivity of FNAC varying from 48% to 92%, the specificity ranging from 94% to 100%, the PPV ranging from 83% to 100%, and the NPV ranging from 59% to 78%. [9][10][11][12][13][14][15][16] False-negative rates in the literature were reported to be between 8% and 24%. [12][13][14][15][16][17][18] The main reason for false-negative FNAC results appears to be the small size of the metastasis.…”

Section: Resultsmentioning

confidence: 99%

Ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management

Iwamoto

Aruga

Horiguchi

et al. 2019

Diagnostic Cytopathology

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Background: The objective of this study was to evaluate the accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes (LN) in breast cancer, to compare the results of FNAC and pathological examination, and to distinguish patients with 1 to 2 metastatic LNs from those with ≥3 metastatic LNs in patients with FNAC-positive patients. Patients and Methods: This study included 198 breasts of 196 patients with breast cancer who underwent FNAC and surgery for the primary and axilla without neoadjuvant chemotherapy from January 2010 to August 2016. Axillary nodal status was assessed by ultrasound (US), and whether FNAC-positive had three or more suspicious LNs on US imaging was examined. Results: The results of FNAC were positive in 75 (38%), negative in 97 (49%), suspicious in 2 (1%), indeterminate in 5 (2.5%), and insufficient in 19 patients (9.5%). FNAC sensitivity, specificity, positive predictive value, and negative predictive value were 62.6%, 100%, 100%, and 62.0%, respectively. Whereas 53% (18/34) of patients with false-negative FNAC had one metastatic LN on final pathology, 61% (47/77) patients who were FNACpositive had three or more metastatic LNs. In the FNAC-positive patients, all patients had ≥3 metastatic LNs if they had ≥3 suspicious LNs on US imaging. Conclusion: Patients with positive cytology were more likely to have ≥3 positive LNs compared to false-negative cytology patients. Patients with ≥3 abnormal LNs on US and positive FNAC might require axillary dissection.

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“…Many studies have been performed to define the value of axillary FNAB as a diagnostic test in patients with primary breast cancer with reported sensitivity and specificity figures ranging from 40 to 91% and 90 to 100%, respectively [13-25]. …”

Section: Resultsmentioning

confidence: 99%

“…Axillary micrometastases may also contribute to the moderate false negative rate associated with FNAB [11, 13, 21]. …”

Section: Resultsmentioning

confidence: 99%

Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma

2019

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Context: Fine-needle aspiration biopsy (FNAB) is frequently used to stage the axilla preoperatively in patients with primary breast carcinoma. In the light of the ACOSOG-Z0011 and AMAROS trials that specified sentinel lymph node biopsy as an inclusion criterion, the role of FNAB in axillary staging is changing. Objective: This article will review the diagnostic accuracy of FNAB in staging of the axilla in patients with primary breast carcinoma. The efficacy of axillary FNAB compared with core-needle biopsy will be evaluated. The evolving approach to staging of the axilla, in the light of ACOSOG-Z0011 and AMAROS trials, will be discussed. Data Sources: Data were sourced from published peer-reviewed articles in PubMed (US National Library of Medicine) and published guidelines including the European Guidelines for Quality Assurance in Breast Cancer and those from the European Society of Medical Oncology (ESMO), Union for International Cancer (UICC), American Society of Clinical Oncology (ASCO), and the American Society of Breast Surgeons. Conclusions: FNAB of the axilla is almost 100% specific with a sensitivity between 40 and 90%. A positive FNAB reduces the need for a second axillary procedure by up to 20% with reduced morbidity and cost. The recent ACOSOG-Z0011 and AMAROS trials have reduced the use of FNAB axilla in American protocols, but it remains the standard of care in Europe.

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Preoperative Fine Needle Aspiration of Axillary Lymph Nodes in Breast Cancer: Clinical Utility, Diagnostic Accuracy and Potential Pitfalls

Cited by 16 publications

References 21 publications

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

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

Ultrasound‐guided fine‐needle aspiration of axillary lymph nodes in breast cancer: Diagnostic accuracy and role in surgical management

Fine-Needle Aspiration Biopsy Management of the Axilla in Primary Breast Carcinoma

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