Ultrasound and fine needle aspiration cytology of the axilla in the pre-operative identification of axillary nodal involvement in breast cancer

Swinson, C M; Ravichandran, D.; Nayagam, M; Allen, Steven

doi:10.1016/j.ejso.2009.03.008

Cited by 61 publications

(55 citation statements)

References 14 publications

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“…Various studies have reported the sensitivity and specificity rates of FNAB between 25-95% and 97-100%, respectively (8,14,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). False positive results has been reported around 1.4-1.6% (20,23,30), and false negative rates as 8-12% (15,23,24,26,(29)(30)(31).…”

Section: Factors Influencing Sensitivity and Specificity Ratesmentioning

confidence: 99%

Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging

Akıncı

Bulut

Erözgen

et al. 2016

UCD

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, 46 women were prospectively enrolled in the study. Ultrasound guided-FNABs for axillary assessment were performed preoperatively. Cytology results were compared with histopathology reports to determine its sensitivity, specificity, negative and positive predictive value and accuracy.Results: Nineteen cases that had malignant cytology on FNAB also had axillary involvement in axillary lymph node dissection (ALND) without any false-positive results. The sensitivity and specificity of US-guided FNAB were 63.3% and 100%, respectively. US-guided FNAB was accurate in predicting the status of the axilla in 76.1% of patients. Conclusion:Although this technique is favorable due to its minimally invasive nature, it is not as effective as sentinel lymph node biopsy (SLNB) in terms of detecting axillary metastasis preoperatively. The low sensitivity and low accuracy rates decrease the usefulness of the technique. Therefore, it seems that US-guided FNAB alone could not replace SLNB. Nevertheless, combining some other molecular studies may be useful in increasing the technique's sensitivity. These issues should be determined by comprehensive clinical trials.Keywords: Breast cancer, axillary ultrasound, axillary staging, axillary lymph node sampling, axillary fine-needle aspiration biopsy Ulus Cerrahi Derg 2016; 32: 191-196 DOI: 10.5152/UCD.2015.2913 Original Investigation and/or ultrasound or had palpable breast lump confirmed by tru-cut biopsy as invasive breast cancer constituted the study group. ABSTRACT Patient Selection CriteriaThis study included clinically node-negative early breast cancer patients. Patients with a previous history of axillary-breast surgery and/or axillary-breast radiotherapy and those diagnosed with excisional biopsy were excluded. Patients who received neo-adjuvant chemotherapy were also excluded.All patients' demographic properties, tumor characteristics (size, grade, estrogen, progesterone receptor status, HER-2 neu status), cytopathology results of FNAB and SLNB, and post-operative pathologic findings were prospectively recorded. The FNAB, SLNB, and ALND data were compared and evaluated along with patient and tumor characteristics. Radiologic Technique and CriteriaPatients who were histopathologically diagnosed with breast cancer preoperatively were referred to the interventional radiology department for axillary lymph node FNAB. The FNABs were performed by one particular radiologist experienced in breast ultrasound before the surgical intervention, after evaluating the axillary lymph node status in gray-scale using 13.5 mHz linear probe and Hitachi Avius High Vision device.

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Section: Factors Influencing Sensitivity and Specificity Ratesmentioning

confidence: 99%

Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging

Akıncı

Bulut

Erözgen

et al. 2016

UCD

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“…Ultrasound is neither sufficiently sensitive nor specific to be used alone; in patients with indeterminate cortical thickening in the range of 2-4 mm, it is essential to assess whether such patients have involved nodes by FNAC or core biopsy. [20][21][22][23] The majority of surgeons continue to perform ANC which is an appropriate treatment for involved axillary nodes. Axillary radiotherapy is another option for involved nodes, and this is used in some centres and has been shown to produce good long-term disease control rate.…”

Section: Discussionmentioning

confidence: 99%

A further survey of surgical management of the axilla in UK breast cancer patients

Glynn

Williams

Dixon

2010

annals

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Ann R Coll Surg Engl 2010; 92: 506-511 506Breast cancer has the highest incidence of any cancer in the UK with over 45,000 new cases diagnosed each year. 1 Axillary node status is recognised as the single most important prognostic indicator of survival in these patients. Since the advent of effective surgical management of breast cancer by Halsted at the end of the 19th century, 2 and his use of radical mastectomy with axillary lymph node dissection, there has been a continual effort to optimise locoregional surgery, both in terms of morbidity and mortality for breast cancer patients. A key component to this effort has been the development of an appropriate method of assessing the status of the axillary lymph nodes following on from the introduction of four-node sampling (ANS) over 30 years ago. 3,4 The incorporation of sentinel lymph node biopsy (SLNB), originally pioneered in penile cancer in the late 1970s 5 and then adapted for use with melanoma patients, 6 into breast cancer management began in 1993.7 This first report documented the identification of SLNB with radioisotopes; the following year, SLNB localisation using blue dye alone was reported by Giuliano et al. 8 Finally, Albertini et al. 9 introduced the concept of combining radioactive isotope and blue dye ('dual localisation') in 1996. A recent meta-analysis of over 8000 patients concluded that dual localisation is the method for optimising identification of the SLNB; 10 indeed, this is the method being introduced across the UK as part of the NEW START training programme.Surgeons today are faced with a variety of options when considering how best to assess and manage the axilla including: observation only; SLNB with dye only; SLNB with isotope only; SLNB with dual localisation; blind ANS; bluedye-assisted ANS; and/or an axillary lymph node dissection (ALND). Even within these options, there are further decisions to be made, including the optimal site of injection of radioisotope or dye, and which is the best dye or radioisotope to use. Added to this, there are issues in relation to the value of internal mammary node dissection, the role and value of scintigraphy, and pre-operative axillary ultrasound and percutaneous axillary node core biopsy and fine-needle aspiration (FNA). Furthermore, once the status of the axilla is established, there then arises the question of how to man- The aims of this study were to investigate the practice of axillary lymph node management within different units throughout the UK, and to assess changes in practice since our previous survey in 2004. SUBJECTS AND METHODS A structured questionnaire was sent to 350 members of the British Association of Surgical Oncology. RESULTS There were 177 replies from respondents who managed more than 100 patients a year with breast cancer. Of these: 12 did not perform axillary ultrasound at all in their centre; 17 (10%) employed axillary node clearance (ANC) on all patients; 122(69%) performed sentinel node biopsy (SNB) with dual localisation; and 111 respondents had attended the New Sta...

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“…Additionally, it is the method of choice for the initial evaluation of the axilla in patients with a diagnosis of carcinoma [13], and allows the initial characterization of symptomatic lesions in young women.…”

Section: Breast Ultrasoundmentioning

confidence: 99%

Imaging diagnosis of young women with breast cancer

Sentís

2010

Breast Cancer Res Treat

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Ultrasound and fine needle aspiration cytology of the axilla in the pre-operative identification of axillary nodal involvement in breast cancer

Cited by 61 publications

References 14 publications

Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging

Predictive value of fine needle aspiration biopsy of axillary lymph nodes in preoperative breast cancer staging

A further survey of surgical management of the axilla in UK breast cancer patients

Imaging diagnosis of young women with breast cancer

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