Ultrasound and fine needle aspiration cytology of axillary lymph nodes in breast cancer. To do or not to do?

Leenders, M.W.H.; Broeders, M.; Croese, C.; Richir, Milan C.; Go, Hideto; Langenhorst, B. L. A. M.; Meijer, Sybren; Schreurs, Wilhelmina H.

doi:10.1016/j.breast.2012.05.008

Cited by 66 publications

(70 citation statements)

References 36 publications

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“…Tahir et al (2008) reported an increase in sensitivity from 47.1% to 80% when two or more nodal metastases were found. Sensitivity, on the other hand, was lower for US 1 FNAC than for US alone, as also reported in the literature (Leenders et al 2012;Park et al 2011).…”

Section: Discussionsupporting

confidence: 62%

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Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention?

Moorman

Bourez

Leeuw

et al. 2015

Ultrasound in Medicine & Biology

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Section: Discussionsupporting

confidence: 62%

“…There are a number of reasons for this discrepancy. First, the prevalence of axillary metastases in the study populations differs greatly, ranging between 25% and 58% (Leenders et al 2012). In our study, the prevalence of nodal metastases was 28.4%, which is relatively low compared with values in the literature.…”

Section: Discussioncontrasting

confidence: 62%

Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention?

Moorman

Bourez

Leeuw

et al. 2015

Ultrasound in Medicine & Biology

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“…With the availability of Ax US & SLNB techniques, ability to gather this information peri-operatively has improved greatly [16]. Leenders et al (2012) reported sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of axillary ultrasound alone as 43.8 % (188/429), 80.7 % (582/721), 57.5 % (188/327) and 70.7 % (582/823), respectively. They also reported sensitivity, specificity, PPV, NPV of Ax US + FNAC as 24.7 % (106/429), 99.9 % (720/ 721), 99.1 % (106/107) and 69.0 % (720/1043) respectively [17].…”

Section: Discussionmentioning

confidence: 99%

“…Leenders et al (2012) reported sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of axillary ultrasound alone as 43.8 % (188/429), 80.7 % (582/721), 57.5 % (188/327) and 70.7 % (582/823), respectively. They also reported sensitivity, specificity, PPV, NPV of Ax US + FNAC as 24.7 % (106/429), 99.9 % (720/ 721), 99.1 % (106/107) and 69.0 % (720/1043) respectively [17]. Similarly Fernandez et al (2012) found that when compared with final axillary histology, ultrasound fine-needle aspiration showed positive predictive value of 87 %, negative predictive value of 82 %, sensitivity of 53 % and specificity of 100 % [12].…”

Section: Discussionmentioning

confidence: 99%

Role of Axillary Ultrasound, Fine Needle Aspiration Cytology and Sentinel Lymph Node Biopsy in clinically N0 Breast Cancer

Goel

Janaki

Smitha

et al. 2016

Indian J Surg Oncol

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This study evaluates the combined role of axillary ultrasound, fine needle aspiration cytology and sentinel lymph node biopsy in clinically N0 axilla. Between January 2014 and June 2015, 150 women with early breast cancer underwent axillary ultrasound as a first investigation for nodal status. Suspicious nodes were subjected to image guided fine needle aspiration cytology. Non-suspicious and fine needle aspiration cytology negative axillary nodes proceeded to sentinel lymph node biopsy at time of primary breast surgery. All confirmed positive (cytology and frozen) cases proceeded to axillary lymph node dissection. 52 women had positive axillary nodes at final histology. Axillary ultrasound with fine needle aspiration cytology identified 27 patients with positive axillary nodal status and had a sensitivity of 84.36 % (27/32) and specificity of 87.5 % (14/16). Intraoperative frozen analysis identified a further 13 cases with sensitivity of 56.52 % (13/23) and specificity of 97.56 % (80/82). Overall 76.92 % (40/52) patients with positive axillary metastasis were identified peri-operatively using combination of axillary ultrasound, cytology and sentinel lymph node biopsy.

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“…Further it is possible that small metastases not previously identified by standard histopathology may be detected. Previous work has demonstrated that increasing interrogation of lymph nodes, histologically, using a 2 mm step sectioning protocol upstaged between 7% and 42% of cases when compared to a single section and that the use of OSNA increases the rate of detection of micro-metastases [7] [8].…”

Section: Introductionmentioning

confidence: 99%

Sensitivity and Specificity of Pre-Operative Staging of the Axilla When Using OSNA in Breast Cancer Patients

Horsnell¹,

Choudhry²,

Urriza-Rodriguez³

et al. 2016

ABCR

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Introduction: All patients with a new diagnosis of breast cancer undergo pre-operative axillary ultrasound (US) and biopsy to identify axillary metastases. The efficacy of this approach at identifying metastatic disease is particularly important if an intra-operative technique of assessment is used. This paper is the first to report the sensitivity and specificity of pre-operative axillary ultrasound within the context of the routine use of OSNA (one step nucleic acid amplification) (Sysmex, Japan), a molecular assay technique for the intra-operative analysis of axillary lymph nodes. This knowledge will help counsel patients prior to the procedure and inform economic analysis of the implications of this approach. Method: Consecutive patients diagnosed with invasive breast cancer between July 2009 and February 2012 at a single centre were identified by interrogation of MDT (multi disciplinary team) and surgical databases and a prospective database of all patients undergoing OSNA analysis. A standardised data collection sheet was used to record tumour characteristics and the nodal stage for each patient. These results were used to document the efficacy of preoperative US and biopsy of the axilla in comparison to intraoperative OSNA analysis. The data were then compared between two groups of patients, those whose nodes had been assessed using OSNA (the OSNA group) and those nodes had been tested using standard histopathological examination (the non-OSNA group). Results: A total of 377 eligible patients were identified. Within the OSNA group (n = 240) the sensitivity of pre-operative axillary US was 29% which rose to 41% when micro-metastases were excluded. A specificity and positive predictive value of 100% was recorded. The negative predictive value was 74%. There were no significant differences to the efficacy when the nodes were assessed with standard histopathology. The detection rate of micro-metastases was significantly higher in the OSNA group (P = 0.001), but there was no statistically significant difference in those with macro-metastases (P = 0.457). Conclusions: There are no * Corresponding author. J. D. Horsnell et al. 104significant differences in the sensitivity and specificity achieved by pre-operative axillary US when compared to either post operative histopathology or OSNA molecular analysis as the gold standard. OSNA, however, does increase the detection of micro-metastases.

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Ultrasound and fine needle aspiration cytology of axillary lymph nodes in breast cancer. To do or not to do?

Abstract: 106/429 (24.7%) Node-positive axillae were identified by ultrasound-guided FNAC and spared unnecessary sentinel node biopsy. Unfortunately, the percentage of false negative results of ultrasound-guided FNAC (28.1%, 323/1150) was very high.

Cited by 66 publications

References 36 publications

Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention?

Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention?

Role of Axillary Ultrasound, Fine Needle Aspiration Cytology and Sentinel Lymph Node Biopsy in clinically N0 Breast Cancer

Sensitivity and Specificity of Pre-Operative Staging of the Axilla When Using OSNA in Breast Cancer Patients

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