Synergy of cytological methods in the pathological staging of breast cancer: Axillary fine‐needle aspiration and intraoperative scrape cytology of the sentinel lymph node

Abstract

Background Sentinel lymph node biopsy (SLNB) has become the standard in breast cancer staging, but it is costly and time‐consuming. Fine‐needle aspiration cytology (FNAC) under ultrasonographic guidance identifies patients who need axillary lymph‐node dissection (ALND), thus reducing costs. As an alternative to frozen sections (FS), intraoperative scrape cytology (ISC) for SLNB is an inexpensive, rapid, accurate and safe technique. We evaluated the synergy of FNAC and SLNB in determining the axillary burden and the performance of the ISC method. Methods Over a nine‐year period, 894 breast cancer patients were analyzed. Of these, 439 patients with echographic suspicious nodes underwent preoperative FNAC; negative axillary ultrasounds or FNACs resulted in 606 intraoperative SLNB, performed using the ISC technique. The results were compared with histological diagnosis, and sensitivity, specificity, predictive values and accuracy were calculated. Results Of the 439 FNACs, 121 were positive and underwent immediate ALND, and 242 negative patients underwent intraoperative SLNB (69% sensitivity, 99% specificity). Positive cases often had multiple nodal involvement (55% pN2‐3). Of the 606 SLNB‐ISC smears, 510 were true negative; 65 true positives allowed for one‐step ALND (71% sensitivity, 99% specificity). Conclusion Preoperative positive axillary FNAC predicts a higher disease burden and determines the avoidance of SLNB for patients eligible for immediate ALND. ISC instead of FS is a safe and sensitive technique to identify metastases, indicating completion of ALND. Partially presented at Joint International Oncology (sentinel node & cancer metastasis) Congress, May 27‐29, 2013, San Francisco, California, USA 18 ° International Congress of Cytology (ICC 2013‐1161), May 26‐30, 2013, Paris, France Convegno Nazionale GISMa ‐ Finalborgo (Savona), Italy,19‐20 maggio 2016

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

“…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 , <...>…”