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Axillary fine needle aspiration cytology for pre-operative staging of patients with screen-detected invasive breast carcinoma
  1. Brian D Hayes1,
  2. Linda Feeley2,
  3. Cecily M Quinn1,3,
  4. M M Kennedy2,4,
  5. Ann O'Doherty3,
  6. Fidelma Flanagan4,
  7. Anna Marie O'Connell5
  1. 1Department of Histopathology, St Vincent's University Hospital, Dublin 4, Ireland
  2. 2Department of Histopathology, Mater Misericordiae University Hospital, Dublin 1, Ireland
  3. 3Merrion Breast Screening Unit, St Vincent's University Hospital, Dublin 4, Ireland
  4. 4Eccles Breast Screening Unit, Mater Misericordiae University Hospital, Dublin 1, Ireland
  5. 5BreastCheck West, University College Hospital, Galway, Ireland
  1. Correspondence to Brian D Hayes, Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; brian_hayes{at}ireland.com

Abstract

Introduction Fine needle aspiration cytology (FNAC) of radiologically abnormal axillary lymph nodes in patients with breast cancer can identify patients suitable for primary axillary clearance (AC) rather than sentinel node biopsy, enabling surgical axillary staging by a single operation. This study assessed the accuracy of FNAC in predicting positive axillary lymph nodes.

Methods 161 patients with screen-detected invasive carcinoma and who had pre-operative FNAC of a radiologically abnormal axillary lymph node were identified from two screening units, The axillary FNAC reports were correlated with sentinel node biopsy and AC reports, and sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated.

Results FNAC had a moderate sensitivity (66.3%) and NPV (71.8%), and a high specificity (98.7%) and PPV (98.3%). Most patients (86%) had a single axillary operation. The sensitivity was highest in grade 3 (81.8%) and ductal type (77.8%) tumours. The sensitivity was lower in tumours of special type (34.8%), grade 1 tumours (50%) and those without lymphovascular invasion (LVI) (55.9%). The NPV was highest in pT1 (86.7%) and in grade 1 (84.5%) tumours, and lowest (44%) in tumours with LVI. The PPV was 100% in grade 1 and 3 tumours, stage pT2 and pT3 tumours and those without LVI, and was high (>96%) in all other groups. In lymph-node-positive patients, the mean number of lymph nodes involved was higher in the case of a positive (6.4) than negative FNAC (4.4).

Conclusions FNAC of ultrasonically abnormal axillary lymph nodes achieved surgical staging by a single operation in most patients with screen-detected invasive breast carcinoma, with moderate sensitivity and high specificity.

  • Axillary clearance
  • breast cancer
  • cytology
  • FNA
  • sentinel node
  • staging
  • surgery

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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