Prognostic significance of a positive axillary lymph node fine‐needle aspirate in patients with invasive breast carcinoma

Abstract

BACKGROUND: Image-guided axillary lymph node fine-needle aspirates (FNAs) correlate well with pathologic lymph node staging in cases of invasive breast carcinoma. The objective of this study was to determine the prognostic significance of a positive lymph node. METHODS: Consecutive cases of nonmetastatic (M0) invasive breast carcinoma evaluated by image-guided FNA were identified (4-year period, median follow-up of 51 months). "Positive" and "nonpositive" groups were compared using Kaplan-Meier survival analysis. Multivariate Cox regression was used to correct for clinicopathologic and treatment factors. A total of 142 cases was included, 70 with positive axillary FNA and 72 with a nonpositive result. RESULTS: FNA-positive and nonpositive cases did not differ in patient age, tumor subtype, or hormone receptor status. Positive FNA was significantly associated with advanced T and N pathologic stage, and with HER2 (human epidermal growth factor receptor 2) positivity. FNA-positive patients were more likely to undergo mastectomy and to receive chemotherapy. Kaplan-Meier analysis showed that positive FNA is associated with poor prognosis, both with respect to disease-free survival (89% nonpositive versus 73% positive at 5 years, P <.001) and overall survival (94% versus 81%, respectively, at 5 years, P 5.01). Multivariate analysis showed that when correcting for other variables, FNA positivity was not independently significant. CONCLUSIONS: Positive axillary lymph node FNA is associated with poor prognosis on univariate analysis. By contrast, overall nodal staging is independently significant on multivariate analysis.The prognostic significance of axillary FNA likely results from its ability to predict for nodal status. Axillary FNA has utility as a preoperative staging procedure. Cancer (Cancer Cytopathol) 2014;122:138-44.

Receptor-interacting protein kinase 2 promotes triple-negative breast cancer cell migration and invasion via activation of nuclear factor-kappaB and c-Jun N-terminal kinase pathways

“…Axillary lymph node metastasis in primary breast cancers has long been used clinically as a poor prognostic indicator [37] but there remains controversy about whether axillary lymph node metastasis reflects lead-time bias or true tumor biology (that is, metastatic potential or aggressiveness) [37-39]. Multivariate analysis of our combined expression array datasets did not reveal lymph node status to be prognostic for PFS although we found that RIP2 mRNA expression correlated with extensive axillary lymph node invasion in stage-III breast cancer.…”

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care

“…267 This is facilitated by placing the samples in a cell-preservation medium and, after retrieving the tissue fragments for formalin fixation, using the fluid medium for flow cytometry. 267 Lymph node FNAB for cytology can be used as an independent prognostic indicator for metastatic breast cancer, 268 as can the presence of CYFRA 21 keratin biomarker. 269 Fine-needle aspiration biopsy of lymph node can also be used in allergy studies to assess effectively the complex immune reaction following intradermal antigen challenge.…”

Is Liquid-Based Cytology the Magic Bullet for Performing Molecular Techniques?

“…They showed that cases with positive axillary FNA have more advanced disease with poorer prognosis and more aggressive treatment. They concluded that axillary FNA could be used as a preoperative staging procedure [21]. …”