Evaluation of Lymphatic Involvement within Needle Biopsy for Breast Carcinoma. Is It Useful?
M Masako, T Uematsu, K Nagata. Shizuoka Cancer Center Hospital and Research Institute, Nagaizumi, Shizuoka, Japan
Background: Lymph node status is still the most important prognostic factor for disease-free and overall survival in breast carcinoma patients. We evaluated lymphatic involvement in core needle biopsies (CNB) and compared the efficiency for positive lymph node detection, with results from frozen sections (FS), ultrasound (US) or computer tomography (CT) imaging, and fine needle aspirations (FNA).
Design: Six hundred and twelve patients were selected from among 1,106 surgical breast cases in our hospital from 2005 to 2008. Patients with neoadjuvant chemotherapy, ductal carcinoma in situ, benign lesions and recurrences were excluded. The CNB were performed by using 18 G to 11 G needles, and one to six cores were taken. The lymphatic involvement was evaluated by HE staining and occasionally by assistance from immunostaining of antibody D2-40. Lymph nodes were cut every two millimeter for FS. US guided FNA was performed for on any suspected lymph node. Imaging evaluation of lymph nodes using US and/or CT at screening was checked by electronic reports.
Results: One hundred and forty eight patients (24.2%) had positive lymph node(s) and 92 patients (62.2%) had only a single positive lymph node, including 8 patients with isolated tumor cells. Twenty six patients (18.8%) with positive lymph nodes (PLN), and 7 patients (1.5%) without PLN were found to have lymphatic involvement in CNB. Two cases with marked lymphatic involvement in CNB had PLN. PLN were seen in 15 patients (10.1%) by FNA before surgeries and PLN were found in 132 patients (89.2%) by FS. The false negative rate of sentinel lymph nodes in FS was 7.6%. FNA could detect PLN in 25.9 %, and imaging in 37.2%.
Conclusions: The efficiency for detection methods of PLN was best in FS, followed by imaging, FNA and CNB in that order. CNB was not an efficient predictor of PLN, but may be efficient to do negative lymph nodes. Marked lymphatic involvement in CNB should be documented in the reports.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 9, Tuesday Afternoon