Utility of Axillary Lymph Node Fine-Needle-Aspiration in Management of Patients with Breast Cancer
Bella Graber, Joanna McLeod, Kara Kort, Deepa M Masrani, Kamal K Khurana. SUNY Upstate Medical University, Syracuse, NY
Background: Locoregional axillary lymph node status has long been the gold standard in determining the management and prognosis of breast cancer patients. Axillary lymph node fine needle aspiration (FNA) is an important confirmatory test for locally advanced and/or inoperable carcinoma. We present our institutional experience with axillary lymph node FNA in management of patients with breast cancer.
Design: The study included all patients with history of breast cancer that underwent axillary lymph node FNA over a 9 year period and had available subsequent follow up. Cytopathologic findings were reported as “positive/ suspicious for malignancy” and “negative”. FNA results were correlated with surgical pathology outcome (considered the gold standard). The impact of axillary lymph node FNA on subsequent management decisions was also assessed.
Results: Of the 42 cases, axillary FNA was positive/suspicious for malignancy in 26 of 42 (62%) and, negative in 16 of 42 (38%). Palpation guided FNA and ultrasound guided FNA of axillary lymph nodes was performed in 22 (52%) and 20 (48%) cases, respectively. Surgical follow up was available in 41 of these cases. Sensitivity, specificity, positive predictive values and negative predictive values of axillary lymph node FNA were 83%, 100%, 100% and 69%, respectively. Four of 26 positive/suspicious FNA cases represented recurrences in the axilla and were surgically excised. Of the remaining 22 positive/suspicious FNA cases, 21 (96%) were spared sentinel lymph node biopsy and underwent axillary lymph node dissection. Of the 16 negative FNA cases, 10 (62.5%) underwent sentinel lymph node biopsy protocol and 6 underwent axillary lymph node dissection without sentinel lymph node biopsy.
Conclusions: Axillary lymph node FNA has high sensitivity and specificity for assessment of lymph node involvement by breast cancer and obviates the need for sentinel lymph node biopsy in patients with cytopathologic findings that are positive/suspicious for malignancy.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 50, Monday Morning