Axillary lymph node echo-guided fine-needle aspiration cytology enables breast cancer patients to avoid a sentinel lymph node biopsy. Preliminary experience and a review of the literature.
OBJECTIVE
For many years, the status of the axillary lymph nodes has been determined by an axillary lymphadenectomy. However, a sentinel lymph node biopsy has been shown to effectively replace the need for an axillary lymphadenectomy in order to determine the axillary staging. This study presents the preliminary results regarding the efficacy of fine-needle aspiration cytology (FNAC) to identify metastatic axillary lymph nodes in the pre-operative phase.


METHODS
One hundred lymph nodes from 100 patients with histologically and cytologically confirmed breast cancer (cT1-2 cN0) underwent echo-guided FNAC. The diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) for the axillary metastases was evaluated based on the histological findings of either a sentinel lymph node biopsy or an axillary lymphadenectomy as a reference standard.


RESULTS
It was possible to avoid a sentinel lymph node biopsy in 30% of the cases; the sensitivity was 68%, specificity 100%, PPV 100%, and NPV 65%. Echo-guided FNAC of the axillary lymph nodes should thus be included among the regular diagnostic procedures of presurgical staging.


CONCLUSIONS
This simple, inexpensive, and minimally invasive technique makes it possible to avoid the additional cost of a sentinel lymph node biopsy while also sparing the patient the stress of undergoing a second surgery.
Altomare
Vittorio
V
Breast Unit, Campus Bio-Medico University, Rome, Italy.
Guerriero
Gabriella
G
Carino
Rita
R
Battista
Cleonice
C
Primavera
Angelo
A
Altomare
Annamaria
A
Vaccaro
Donata
D
Esposito
Alessandro
A
Ferri
Anna Maria
AM
Rabitti
Carla
C
D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology*; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
Eur J Cancer. 2003 May;39(8):1068-73
12736105
Am J Surg. 2004 Jun;187(6):679-83
15191856
Radiology. 1992 Apr;183(1):215-20
1549675
Radiol Med. 2004 Oct;108(4):345-55
15525888
Eur J Cancer. 2003 Jan;39(2):170-4
12509948
Radiology. 1986 Feb;158(2):325-6
3510440
Br J Surg. 1999 Nov;86(11):1459-62
10583296
Eur Radiol. 2000;10(9):1464-71
10997438
Tumori. 2001 Sep-Oct;87(5):277-87
11765174
J Ultrasound Med. 1996 Mar;15(3):241-6
8919506
Br J Cancer. 2003 Mar 10;88(5):702-6
12618878
Ann Chir Gynaecol. 1990;79(1):15-8
2192685
Lancet. 1997 Jun 28;349(9069):1864-7
9217757
Eur J Nucl Med. 1996 May;23(5):498-503
8698052
Cancer. 1983 Nov 1;52(9):1551-7
6352003
Ultraschall Med. 1998 Apr;19(2):70-7
9654672
Cancer. 2002 Sep 1;95(5):982-8
12209680
Q J Nucl Med Mol Imaging. 2004 Jun;48(2):109-18
15243412
J Clin Ultrasound. 1997 Feb;25(2):53-6
9023691
Ann Surg. 2002 Nov;236(5):619-24
12409668
Ann Surg Oncol. 2004 Sep;11(9):846-53
15313737
Eur J Surg Oncol. 1991 Jun;17 (3):240-4
2044777
Eur J Surg Oncol. 1996 Apr;22(2):140-3
8608829
Breast Cancer Res Treat. 2002 Jan;71(2):171-3
11881913
Breast Cancer. 1999 Jul 25;6(3):249-258
11091725
AJR Am J Roentgenol. 2001 Apr;176(4):1069-74
11264113
Eur J Surg Oncol. 1989 Apr;15(2):139-41
2649395
Ann Chir. 2001 Sep;126(7):654-8
11676237
Breast Cancer Res Treat. 2005 Jan;89(1):69-74
15666199
Am J Surg. 2002 Oct;184(4):307-9
12383889
Eur Radiol. 2001;11(12 ):2425-35
11734935
World J Surg. 1997 Mar-Apr;21(3):270-4
9015169
J Ultrasound Med. 1989 Mar;8(3):115-20
2657088
Radiology. 2000 May;215(2):568-73
10796941
Radiol Clin North Am. 2000 Jul;38(4):809-23
10943279
Radiology. 1997 Dec;205(3):831-5
9393544
Ann Surg. 1994 Sep;220(3):391-8; discussion 398-401
8092905
Int J Oncol. 2002 Mar;20(3):483-7
11836558