[377] Diagnostic Value of FNA Processed by ThinPrep for Assessment of Axillary Lymph Node Status in Patients with Invasive Carcinoma of Breast

Xin Jing, Elizabeth Wey, Claire W Michael. The University of Michigan Health System, Ann Arbor, MI

Background: Ultrasound-guided FNA has been widely utilized as an important modality in determination of axillary lymph node status during the initial staging and subsequent management of patients with invasive breast carcinoma. Tranditionally, the aspirates are processed as conventional smears. However, in the current study, we evaluated the utility of the use of ThinPrep as a more standard method for detection of axillary lymph node metastasis of invasive breast carcinoma.
Design: A Computer SNOMED Search from the file at our institution between 01/20003 and 08/2011 was conducted to identify patients with invasive breast carcinoma who were worked-up by FNA of axillary lymph node and followed by axillary lymph node dissection. We retrieved a total of 209 FNAs processed by ThinPrep including 193 and 16 diagnostic and non-diagnostic specimens, respectively. The 193 diagnostic specimens consisted of 168 invasive ductal carcinoma (IDC), 15 invasive lobular carcinoma (ILC) and 10 mixed carcinoma(IDC and ILC). Using the histology diagnosis as the golden standard, the diagnostic parameters were determined. Slides from cyto-histologic discrepant cases were re-reviewed.
Results:

ThinPrep for assessment of axillary lymph node status in patients with invasive breast carcinoma
ParametersIDCILC/Mixed carcinomaTotal
True positive11016126
True negative32436
False positive000
False negative26531
Sensitivity (%)817680
Specificity (%)100100100
PPV (%)100100100
NPV (%)534454
Accuracy (%)848084
PPV: positive predictive value; NPV: negative predictive value.

Using FNA processed by ThinPrep for assessment of axillary lymph node status in patients with invasive breast carcinoma:
1) Ninety-two percent of the specimens are adequate for cytologic diagnosis.
2) Both diagnostic sensitivity and accuracy for detection of lLC/mixed carcinoma (76%, 80%) are slightly lower than that of IDC (81%, 84%).
3) NPV for detection of IDC (53%) is greater than that of ILC/mixed carcinoma (44%).
4) Both specificity and PPV reach 100% regardless the types of invasive breast carcinoma.
5) Sampling error is the major factor contributing to false negative cytolgy interpretation.
Conclusions: Compared to the previously reported data on FNA with conventional smear preparation, FNA processed by ThinPrep offers a compatible diagnostic sensitivity while reaching 100% of specificity. It is an efficient and more convenient method for assessment of axillary lymph node status in patients with invasive breast carcinoma.
Category: Cytopathology

Tuesday, March 20, 2012 9:30 AM

Poster Session III # 82, Tuesday Morning

 

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