Concordance of Fine Needle Aspiration, Sentinel Lymph Node, and Axillary Dissection in Assessing Nodal Metastasis in Breast Cancer Patients
Lauren N Parsons, Behnaz Behmaram, Zainab Basir. Medical College of Wisconsin, Milwaukee, WI
Background: Assessment of axillary lymph node metastasis is essential in the management of patients with breast cancer. While axillary lymph node dissection (ALND) provides a definitive histologic diagnosis it can result in significant morbidity. In addition, recent studies indicate that patients with limited nodal disease may not benefit from ALND. Fine needle aspiration cytology (FNAC) and sentinel lymph node (SLN) biopsy with frozen section analysis (FS) are alternative methods for determining nodal status which are significantly less invasive. We sought to examine the concordance of FNAC, SLN FS, and ALND in our institution to determine the utility of these methods.
Design: A database search was performed for cases of axillary lymph node FNACs from 01/07 to 08/12; of these, cases with corresponding ALND and/or SLN FS were selected. Pathologic data including histologic type, grade, and hormonal status were obtained. Clinical data including radiographic findings were acquired from the patient medical record.
Results: Forty-seven FNAC results from 41 patients with corresponding SLN FS/ALND were identified. Cases in which FNAC demonstrated metastatic disease proceeded directly to ALND without further assessment of SLN status. Thirty-six (77%) of the 47 FNACs were concordant with the ALND and radiographic findings. Of the 11 discordant cases, three cases were diagnosed as “negative for malignancy” by FNAC with subsequent positive SLN-FS and were attributed to sampling error. Six cases that were diagnosed as “positive for malignancy” by FNAC were observed in patients who underwent neo-adjuvant chemotherapy prior to surgery; ALND in these patients showed no metastatic disease. Two cases diagnosed as “positive for malignancy” by FNAC showed no metastasis on ALND; in both, radiologic findings were of low suspicion for metastatic disease. FNAC and SLN-FS were concordant in 17/19 cases (89%), and SLN FS and ALND findings were congruent in 18/19 cases (95%).
Conclusions: We report the concordance of axillary lymph node FNAC with SLN FS and ALND in the management of breast cancer at our institution. In our experience, FNAC and SLN FS show good concordance with each other and with ALND findings. We propose that in cases of discordant FNAC and radiographic findings, nodal status assessment via SLN-FS should be done prior to performing ALND, thereby reducing patient morbidity. Our findings also suggest that in concordant cases and for patients treated neo-adjuvantly prior to surgery, SLN FS can be forgone for routine histologic evaluation.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 31, Tuesday Morning