Sparing sentinel node biopsy through axillary lymph node fine needle aspiration in primary breast cancers

Abstract

BackgroundAxillary lymph node status is an important staging and prognostic factor in breast cancer. This study aimed to evaluate the efficacy of axilla fine needle aspiration cytology (FNAC) in primary breast cancer without a palpable node and even without image characteristics of a metastatic node.MethodsFrom June 2008 to January 2012, 77 patients met the inclusion criteria of having received a FNAC procedure during the diagnostic protocol of primary breast cancer with the characteristic of impalpable axilla nodes, and of having received axillary surgery after that, according to the guidelines. The patients’ characteristics, clinical-pathological features, pre-operative axillary lymph node FNAC findings, surgical lymph node report, and definite pathologic staging were reviewed.ResultsThe FNAC procedures had a reported sensitivity of 58.82%, specificity of 100%, positive predictive value of 100%, negative predictive value of 72.55%, and accuracy of 80.28%. There were no false positives on FNAC; therefore, the positive likelihood ratio approached infinity. The negative likelihood ratio was 41.18%. Axillary lymph node FNAC is feasible in newly diagnosed breast cancer patients to evaluate metastatic lymph nodes even in those without clinical or ultrasonic evidence of lymphadenopathy.ConclusionsFNAC can be a routine evaluation for most primary breast cancer patients with benefits in expediting treatment. For those patients with positive findings of the axilla, sentinel node biopsy can be avoided.

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

“…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 .…”

Perinodal fibrosis developed after ultrasonography‐guided core‐needle biopsy of a contrast‐enhanced ultrasound‐detected sentinel axillary node interferes with subsequent surgical sentinel node dissection

“…In our study, we followed the rationale of guiding the CNB to the lymph node cortex, where early metastatic tumor deposits develop . However, the CEUS technique justifies and enables percutaneous CNB of small benign‐appearing lymph nodes with a very thin cortex .…”

“…Axillary ultrasonography (US) followed by fine‐needle aspiration cytology (US + FNAC) or core‐needle biopsy (US + CNB) of suspicious lymph nodes identifies approximately 50% of patients with axillary lymph node metastases . Recent reports suggest that US + CNB may be superior to US + FNAC in this setting.…”

“…19 Axillary ultrasonography (US) followed by fine-needle aspiration cytology (US + FNAC) or core-needle biopsy (US + CNB) of suspicious lymph nodes identifies approximately 50% of patients with axillary lymph node metastases. [20][21][22][23][24][25][26][27][28][29][30] Recent reports suggest that US + CNB may be superior to US + FNAC in this setting. An insufficient sample is a common limitation of US + FNAC because of the use of a smaller needle.…”

“…[19][20][21] US + CNB decreases the prevalence of axillary SLNB involvement and the prevalence of extensive axillary involvement (>2 compromised lymph nodes) to approximately 20% and 5%, respectively. [22][23][24][25][26] The main reason for the false-negative results of axillary US is the normal or benign appearance of some axillary lymph nodes harboring metastatic tumor deposits. Also, the radiologist often fails to accurately identify the SLN, which is the most likely involved node.…”