Preoperative morphological diagnosis of axillary lymph nodes in a breast center consultation service: evaluation of fine-needle aspiration and core biopsy techniques
Preoperative routine examination of axillary lymph nodes (ALN) in breast cancer patients is carried out physically and by ultrasound imaging; unsuspicious nodes will lead to a sentinel node (SN) procedure, suspicious ones require axillary dissection (AD). Pre-operative biopsy techniques like fine needle aspiration (FNA) or core biopsy (CB) may reduce the number of false “suspicious” cases and prevent overtreatment. We evaluated the effectiveness of both biopsy techniques.
Materials and methods
After physical and ultrasound examination 241 suspicious ALNs were found in 214 patients. Ultrasound-guided FNA and/or CB procedures were chosen randomly, resulting in 138 FNA and 86 CB. In 17 further events both FNA and CB were employed. The samples were examined in our Cytology lab or in the Pathology Department and the findings correlated with post-operative histological lymph node reports. Patients with histologically proven breast cancer underwent sentinel node biopsy, cytologically or histologically positive FNA/CB-findings prompted ALN dissection.
Out of 155 FNA samples 34 were not representative (21.9%), 89 showed no tumor cells (57.4%), 30 showed positive tumor cells (19.4%), leaving two missing. All 103 CB showed representative material, positive in 62 (60.2%) and negative in 41 (39.8%) cases. Correlation with histological reports revealed a statistically non-significant advantage for CB over FNA regarding total accuracy (92.9% vs. 78.3%) and sensitivity (92% vs. 73.7%).
Preoperative CB and alternative FNA are valuable complementary methods of predicting ALN involvement in breast cancer patients and may spare the patient unnecessary ALN dissection.
KeywordsBreast cancer Axillary lymph node Morphology Core biopsy Fine needle aspiration
GPB: data analysis, manuscript writing, editing. JHU: data collection, management and analysis (part of dissertation). RMB: morphology review, data analysis and processing. IJB: project conceptualization, supervision, data analysis, manuscript. BL: cytology data collection, management and processing. FZT: data analysis and processing. EFS: supervision, manuscript review, editing. SJB: project conceptualization, data analysis, manuscript review.
This study was not funded.
Compliance with ethical standards
Conflict of interest
All authors (GP Breitbach, JH Uhlmann, RM Bohle, I Juhasz-Boess, B Linxweiler, FZ Takacs, EF Solomayer, S Juhasz-Boess) declare that they have no conflict of interest.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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