Top

23-10-2017 | Breast cancer | Article

Pre-operative Axillary Ultrasound-Guided Needle Sampling in Breast Cancer: Comparing the Sensitivity of Fine Needle Aspiration Cytology and Core Needle Biopsy

Journal: Annals of Surgical Oncology

Authors: Ashley R. Topps, MBBS, MA, MS, FRCS, Simon P. Barr, MB ChB, MSc, MRCS, Panagiotis Pikoulas, MD, Susan A. Pritchard, BSc, MB ChB, FRCPath, Anthony J. Maxwell, MB ChB, FRCSEd, FRCR

Publisher: Springer International Publishing

Abstract

Background

Pre-operative ultrasound-guided needle sampling (UNS) of abnormal axillary lymph nodes in breast cancer can identify patients with axillary metastases and therefore rationalize patient care and inform decision-making. To obtain tissue diagnosis, UNS can be performed by either fine needle aspiration (FNA) or core needle biopsy (CNB). However, few studies have compared the sensitivity of these techniques and the majority show no difference.

Methods

All node-positive patients (those with micro- and macrometastases but not isolated tumor cells) treated at a tertiary referral center between January 2012 and December 2015 were retrospectively identified from pathology records. The result of the first axillary UNS performed on each patient was compared with postoperative histopathology results. The UNS method used was according to individual radiologist preference.

Results

A total of 215 patients underwent FNA (1 patient had bilateral breast cancer and underwent bilateral FNA), and 92 underwent CNB. Sensitivity of CNB was significantly higher than FNA (83.7 vs. 69.0%, P = 0.008). The false-negative rate in the FNA group was therefore higher than in the CNB group by a factor of 2.5. There was no difference in inadequacy rate between the two techniques. There were no complications in the FNA group, and only one hematoma (which did not require operative intervention) in the CNB group.

Conclusions

CNB is safe and should be the preferred technique for UNS to improve sensitivity.

Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. JAMA 2011; 305:569–575CrossRefPubMedPubMedCentral

Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013; 310:1455–61CrossRefPubMedPubMedCentral

Houssami N, Ciatto S, Turner RM, Cody HS, Macaskill P. Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer. Ann Surg 2011; 254:243–251CrossRefPubMed

Diepstraten SCE, Sever AR, Buckens CFM et al. Value of preoperative ultrasound-guided axillary lymph node biopsy for preventing completion axillary lymph node dissection in breast cancer: a systematic review and meta-analysis. Ann Surg Oncol 2013; 21:51–59CrossRefPubMed

Rao R, Lilley L, Andrews V, Radford L, Ulissey M. Axillary staging by percutaneous biopsy: sensitivity of fine needle aspiration versus core needle biopsy. Ann Surg Oncol 2009; 16:1170–1175CrossRefPubMed

Ganott MA, Zuley ML, Abrams GS et al. Ultrasound guided core biopsy versus fine needle aspiration for evaluation of axillary lymphadenopathy in patients with breast cancer. ISRN Oncol. doi:10.1155/2014/703160. eCollection 2014. Accessed 21st August 2016

Rautiainen S, Masarwah A, Sudah M et al. Axillary lymph node biopsy in newly diagnosed invasive breast cancer: comparative accuracy of fine-needle aspiration biopsy versus core-needle biopsy. Radiology 2013; 269:54–60CrossRefPubMed

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. 7th Edition. New York:Springer 2009

Maxwell AJ, Ridley NT, Rubin G, Wallis MG, Gilbert FJ, Michell MJ. The Royal College of Radiologists Breast Group breast imaging classification. Clin Radiol 2009; 64:624–7CrossRefPubMed

10.

Royal College of Pathologists Pathology reporting of breast disease in surgical excision specimens incorporating the dataset for histological reporting of breast cancer. 2016 www.rcpath.org. Accessed 4th October 2016

11.

Poole GH, Willsher PC, Pinder SE, Robertson JF, Elston CW, Blamey RW. Diagnosis of breast cancer with core-biopsy and fine needle aspiration cytology. Aust N Z J Surg 1996; 66:592–4CrossRefPubMed

12.

Hatada T, Ishii H, Ichii S, Okada K, Fujwara Y, Yamamura T. Diagnostic value of ultrasound guided fine-needle aspiration biopsy, core-needle biopsy, and evaluation of combined use in the diagnosis of breast lesions. J Am Coll Surg 2000; 190:299–303CrossRefPubMed

13.

Lieske B, Ravichandran D, Wright D. Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma. Br J Cancer 2006; 95:62–66CrossRefPubMedPubMedCentral

14.

Britton PD, Goud A, Godward S et al. Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer. Eur Radiol 2009; 19:561–569CrossRefPubMed

15.

Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM. Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy—clinical experience in 100 patients. Radiology 2008; 250:41–49CrossRefPubMed

16.

Topps A, Clay V, Absar M, Howe M, Lim Y, Johnson R, Bundred N. The sensitivity of pre-operative axillary staging in breast cancer: comparison of invasive lobular and ductal carcinoma. Eur J Surg Oncol 2014; 40:813–817CrossRefPubMed

17.

Galimberti V, Cole BF, Zurrida S, et al. Axillary Dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol 2013; 14:297–305CrossRefPubMedPubMedCentral

18.

Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 2014; 15:1303–1310CrossRefPubMedPubMedCentral

19.

Topal U, Punar S, Taşdelen I, Adim SB. Role of ultrasound-guided core needle biopsy of axillary lymph nodes in the initial staging of breast carcinoma. Eur J Radiol 2005; 56:382–385CrossRefPubMed

20.

Cornwell LB, McMasters KM, Chagpar AB. The impact of lymphovascular invasion on lymph node status in patients with breast cancer. Ann Surg 2011; 77:874–7