Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: A prospective study in 144 consecutive patients

Verbanck, J.; Vandewiele, Ignace; Winter, Hilde De; Tytgat, Joos; Aelst, F Van; Tanghe, W

doi:10.1002/(sici)1097-0096(199702)25:2<53::aid-jcu1>3.0.co;2-i

Cited by 83 publications

(70 citation statements)

References 7 publications

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“…We here reported a 16% false negative rate by US alone, since 28 out of 172 of US-nonsuspect LN were positive at histology. However, a great improvement of the diagnostic accuracy emerged when US examination was combined with FNAC of LN suspect to be metastatic, as demonstrated by the few available reports on the subject (Bonnema et al, 1997;Verbanck et al, 1997;de Kanter et al, 1999de Kanter et al, , 2000. In fact, in our study and in previous ones that used a similar approach, the cytological diagnosis of metastases reached 100% specificity.…”

Section: Discussionsupporting

confidence: 53%

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Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

et al. 2003

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The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the diagnosis of LN metastases and subsequently in the treatment of patients with breast cancer. Axillary US was performed in 298 patients with diagnosed breast cancer (267 invasive carcinomas and 31 ductal carcinoma in situ DCIS), and in 95 patients it was followed by FNAC of US suspicious LN. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry (ICC) with a combination of anticytokeratin and anti-HMFG2 antibodies. Eighty-five FNAC were informative (49 LN were positive for metastases, 36 were negative). In 49 of 267 patients with invasive breast carcinoma (18%), a preoperative diagnosis of metastatic LN in the axilla could be confirmed. These patients could proceed directly to axillary dissection. In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN. Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination. Based on these data, US examination should be performed in all patients with breast cancer adding ICC-supported FNAC only on US-suspect LN. This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.

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Section: Discussionsupporting

confidence: 53%

“…There are very few reports of image-guided LN fine-needle aspiration cytology (FNAC) as a means of improving presurgical staging of the axilla in breast cancer patients (Bonnema et al, 1997;Verbanck et al, 1997;de Kanter et al, 1999).…”

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confidence: 99%

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

et al. 2003

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“…In order to increase the specificity of preoperative assessment of the axilla, a number of groups have performed US-guided FNA (Bonnema et al, 1997;Verbanck et al, 1997;De Kanter et al, 1999;Krishnamurthy et al, 2002). Bonnema and de Kanter used this technique to detect axillary metastases in patients with operable breast cancer and preoperatively identified 63% (39 of 62) and 36% (31 of 87) of node-positive patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer

et al. 2003

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The purpose of this study was to examine the use of ultrasound (US)-guided core biopsy of axillary nodes in patients with operable breast cancer. The ipsilateral axillae of 187 patients with suspected primary operable breast cancer were scanned. Nodes were classified based on their shape and cortical morphology. Abnormal nodes underwent US-guided core biopsy/fine needle aspiration (FNA), and the results correlated with subsequent axillary surgery. The nodes were identified on US in 103 of 166 axillae of patients with confirmed invasive carcinoma. In total, 54 (52%) met the criteria for biopsy: 48 core biopsies (26 malignant, 20 benign node, two normal) and six FNA were performed. On subsequent definitive histological examination, 64 of 166 (39%) had axillary metastases. Of the 64 patients with involved nodes at surgery, preoperative US identified nodes in 46 patients (72%), of which 35 (55%) met the criteria for biopsy and 27 (42%) of these were diagnosed preoperatively by US-guided biopsy. In conclusion, US can identify abnormal nodes in patients presenting with primary operable breast cancer. In all, 65% of these nodes are malignant and this can often be confirmed with US-guided core biopsy.

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“…In addition, they found that signs of malignancy were more accurate when lymph nodes measured 10 mm or more in comparison to those that measured less than 10 mm. Two other studies by Kanter et al 16 and Verbanck et al 18 also reported on the utility of US-guided FNA in the preliminary staging of breast carcinoma. The true false-negative rate of US-guided FNA is, however, not apparent from their data.…”

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confidence: 97%

Role of ultrasound‐guided fine‐needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma

Krishnamurthy

Sneige

Bedi

et al. 2002

Cancer

325

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BACKGROUNDUltrasound (US) is more sensitive than physical examination alone in determining axillary lymph node involvement during preliminary staging of breast carcinoma. Due to occasional overlap of sonographic features of benign and indeterminate lymph nodes, fine‐needle aspiration (FNA) of sonographically indeterminate/suspicious lymph nodes can provide a more definitive diagnosis than US alone. This study was undertaken to determine the diagnostic accuracy of US‐guided FNA of indeterminate/suspicious/metastatic‐appearing axillary lymph nodes during the initial staging of breast carcinoma.METHODSThe cytology of 103 cases of US‐guided FNA of nonpalpable indeterminate/suspicious/metastatic‐appearing lymph nodes was compared with the final histopathologic status of the entire axilla after axillary dissection. The final axillary lymph node status was categorized as either negative when all lymph nodes were negative for metastasis or positive when there was evidence of metastasis in one or more lymph nodes. The sensitivity, specificity, diagnostic accuracy, and false‐negative rate of US‐guided FNA of nonpalpable axillary lymph nodes in the preliminary staging process were calculated.RESULTSIn 51 of 103 cases (49.5%), the US‐guided FNA and histopathology were both positive for metastasis. In 24 of 103 cases (23.3%), both were negative. The apparent false‐positive FNA in 16 (15.5%) cases was explained by the complete response of the metastatic lymph nodes to neoadjuvant chemotherapy in the interval between FNA and axillary dissection. In 12 cases (11.6%), US‐guided FNA was negative, but metastasis was seen in histologic sections. All cases with three or more lymph nodes with metastatic disease and 93% of those with metastatic deposit measuring more than 0.5 mm were detected by US‐guided FNA. The probability of detecting lymph nodes with smaller metastatic deposit measuring less than 0.5 cm was 44%. The overall sensitivity of US‐guided FNA was 86.4%, the specificity was 100%, the diagnostic accuracy was 79.0%, the positive predictive value was 100%, and the negative predictive value was 67%.CONCLUSIONSUS‐guided FNA of nonpalpable indeterminate and suspicious axillary lymph nodes is a simple, minimally invasive, and reliable technique for the initial determination of axillary lymph node status in breast carcinoma. The common causes of discrepancy between the initial and final axillary lymph node status include failure to visualize all lymph nodes during US examination, small‐sized metastases, and preoperative neoadjuvant chemotherapy. Cancer 2002;95:982–8. © 2002 American Cancer Society.DOI 10.1002/cncr.10786

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Value of axillary ultrasonography and sonographically guided puncture of axillary nodes: A prospective study in 144 consecutive patients

Cited by 83 publications

References 7 publications

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer

Role of ultrasound‐guided fine‐needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma

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