The Role of Axillary Lymph Node Fine Needle Aspiration in Breast Cancer Staging prior to Chemotherapy with Histological Correlation

Colaizzi, Amy; Kanbour, Anisa; Ibrahim, Ahmed S.; Kanbour‐Shakir, Amal

doi:10.1159/000334659

Cited by 5 publications

(13 citation statements)

References 45 publications

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“…Numerous studies have established the fact that preoperative use of image-guided axillary lymph node FNA obviates the need for sentinel lymph node biopsy in positive cases and helps to select prompt systemic therapy [2,3,4]. Several studies have reported the sensitivity and specificity of axillary FNA to be in the range of 50-85 and 98-100%, respectively [5,6]. Similarly, our study showed 91.7 and 100% sensitivity and ‘true' specificity (after excluding 5 ‘false positive' cases with subsequent postneoadjuvant negative histology), respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Gilani

Fathallah

Al-Khafaji³

2014

Acta Cytologica

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Objective: This study evaluates the diagnostic accuracy of axillary lymph node fine needle aspiration (FNA) cytology in breast cancer and correlates it with clinical parameters/outcomes. Study Design: A total of 91 females underwent FNA of axillary lymph nodes at our institution from January 2007 to February 2013. The cases were classified as ‘positive', ‘negative for malignancy' and ‘nondiagnostic'. Results: Forty-six cases (50.5%) had a histologic follow-up (4.4 ± 3.1 months); of these, 22 (47.8%) were true positive, 7 (15.2%) were true negative, 2 (4.3%) were false negative, 5 (11%) were false positive and 10 (21.7%) were nondiagnostic. However, cytological review of all false positive and false negative cases confirmed the presence or absence of tumor, respectively. All false positive cases had undergone preoperative neoadjuvant chemotherapy, with no residual tumor present, and a treatment effect identified only histologically. Meanwhile, the 2 false negative cases involved micrometastasis (≤1.5 mm). Thus, if we exclude these false positive cases (complete responders), then the sensitivity, specificity, positive predictive value and negative predictive value were 91.7, 100, 100 and 77.8%, respectively. All preoperative FNA-positive axillary lymph nodes were spared from sentinel lymph node biopsy except for 3 of 27 (11.1%). Conclusion: We suggest that axillary lymph node FNA is a highly sensitive technique with a low false negative rate (4.3%) and a diagnostic accuracy of 93.5%.

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Section: Discussionmentioning

confidence: 99%

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

Gilani

Fathallah

Al-Khafaji³

2014

Acta Cytologica

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“…Preoperative evaluation of the axillary lymph nodes has become standard in the management of patients with carcinoma of the breast . It is playing an increasing role in the planning of further management, including surgical approach and neoadjuvant systemic therapy . Definitive nodal staging is based on surgical pathologic evaluation of sentinel lymph node(s) or axillary dissection specimens .…”

Section: Introductionmentioning

confidence: 99%

“…Neoadjuvant treatment is being used increasingly, not only for cases considered inoperable, but for any case in which preoperative evaluation demonstrates a potential benefit for cytotoxic chemotherapy . This depends not only on size, estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 oncoprotein (HER2) status, but also on the result of diagnostic axillary FNA . In a significant subset of neoadjuvant cases, subsequent surgical staging is challenging because of complete or near‐complete treatment response of the tumor .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] It is playing an increasing role in the planning of further management, including surgical approach 7-10 and neoadjuvant systemic therapy. 11,12 Definitive nodal staging is based on surgical pathologic evaluation of sentinel lymph node(s) or axillary dissection specimens. 13,14 However, axillary imaging combined with image-guided fine-needle aspiration (FNA) of selected lymph nodes has proven successful in detecting lymph node metastases prior to surgical management.…”

Section: Introductionmentioning

confidence: 99%

“…[24][25][26] This depends not only on size, estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 oncoprotein (HER2) status, but also on the result of diagnostic axillary FNA. 11,12 In a significant subset of neoadjuvant cases, subsequent surgical staging is challenging because of complete or near-complete treatment response of the tumor. 27 Axillary lymph node FNA is therefore increasing in importance as the first, and sometimes only, opportunity to obtain a tissue-based diagnosis of nodal spread.…”

Section: Introductionmentioning

confidence: 99%

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

Chang

Escallón

Colgan

2013

Cancer Cytopathology

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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.

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Performance characteristics of ultrasound‐guided fine‐needle aspiration of axillary lymph nodes for metastatic breast cancer employing rapid on‐site evaluation of adequacy: Analysis of 136 cases and review of the literature

Fung

Collins

Campassi

et al. 2013

Cancer Cytopathology

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BACKGROUND: It has been demonstrated that axillary ultrasound-guided fine-needle aspiration (US-FNA) has excellent positive predictive value for the axillary lymph node status of patients with breast cancer before surgery or neoadjuvant therapy and, thus, can obviate the need for sentinel lymph node biopsy in FNA-positive patients. However, US-FNA has only moderate sensitivity, in part because of the collection of nondiagnostic or equivocal specimens. Rapid on-site evaluation for adequacy (ROSE) can improve definitive diagnosis rates but has not been well characterized in this setting. METHODS:One hundred thirty-three patients with breast carcinoma were identified who underwent 136 US-FNAs of axillary lymph nodes, all with ROSE, and the results were correlated with the diagnosis on a subsequent surgical procedure. RESULTS:The adequacy rate was 95.6% (130 of 136 FNAs), and a definitive diagnosis was made in 91.2% (124 of 136 FNAs). Among definite diagnoses, sensitivity was 75%, specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 79%. Sources of false-negative and potential false-positive diagnoses were evaluated among these cases and in the literature. CONCLUSIONS: Small metastasis size is the most common cause of falsenegative results, whereas interpretation errors by pathologists are quite rare. ROSE appears to improve adequacy and definitive diagnosis rates and, thus, can more accurately triage patients to appropriate care. Cancer (Cancer Cytopathol) 2014;122:282-91.

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The Role of Axillary Lymph Node Fine Needle Aspiration in Breast Cancer Staging prior to Chemotherapy with Histological Correlation

Cited by 5 publications

References 45 publications

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

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

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

Performance characteristics of ultrasound‐guided fine‐needle aspiration of axillary lymph nodes for metastatic breast cancer employing rapid on‐site evaluation of adequacy: Analysis of 136 cases and review of the literature

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