FNA Is a Highly Accurate Procedure for Detecting Axillary Lymph Node Metastases in Breast Cancer Patients
Rachel E Factor, Barbara E Chadwick, Witt L Benjamin, Lester J Layfield. Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
Background: Patients with biopsy proven breast cancer often undergo lymph node staging prior to surgery or chemotherapy. Recently, at our institution there was a switch from fine needle aspiration (FNA) to predominately core needle biopsy for evaluating atypical axillary lymph nodes, as the radiologists believed more tissue for examination would yield better diagnostic results. While a comparison of these two modalities is the ultimate goal, this study initially sought to determine the diagnostic accuracy of axillary lymph node FNA in patients diagnosed with breast cancer.
Design: A computer search identified patients who underwent axillary lymph node FNA after diagnosis of breast cancer. The pre-test suspicion by ultrasound criteria was noted. The size and histology of the breast tumor, the number of FNA passes performed, and histologic follow-up of the lymph nodes were recorded. For neoadjuvant cases or those without surgical follow-up, two independent cytologists blinded to the cases re-reviewed the FNA cytology. The study was approved by the University of Utah IRB.
Results: 39 breast cancer patients (women, 30 to 89 years of age) underwent axillary FNA from 2003-2011. Tumors were predominantly ductal (97%). From 2003-2009, a cytopathologist performed FNA's on palpable nodes. After 2009, most were performed by a radiologist with an experienced cytopathologist on site for immediate assessment. 14 FNA's were palpable, and 25 FNA's were performed by ultrasound-guidance. 1 (2.6%) case was non-diagnostic but was followed by core biopsy. 2 cases were excluded from analysis. FNA performed by either palpation or ultrasound showed similar results. Overall, 10 (27%) FNA's were called negative and 27 (73%) were called positive or atypical. The sensitivity of FNA was 96% and the specificity was 90%.
Conclusions: FNA is a simple and highly accurate technique for diagnosing axillary lymph node metastases in suspicious lymph nodes. Immediate assessment ensures proper management at the time of the procedure. Additional tissue obtained by core biopsy is not necessary for diagnosis.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 84, Tuesday Morning