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A Positive Node on Ultrasound-Guided Fine Needle Aspiration Predicts Higher Nodal Burden Than a Positive Sentinel Lymph Node Biopsy in Breast Carcinoma

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Abstract

Introduction

Axillary status remains an important prognostic indicator in breast cancer. Certain patients with a positive sentinel node (SLNB) may not benefit from axillary clearance (AC). Uncertainty remains if this approach could be applied to patients diagnosed with axillary metastases on ultrasound-guided fine needle aspiration cytology (USFNAC). The aim of this study was to compare nodal burden in patients with positive USFNAC and a positive SLNB.

Methods

A retrospective study was performed involving all BC patients between 2007 and 2014 who had either pre-operative USFNAC or a SLNB. Patient/tumour characteristics and nodal burden were examined in all patients proceeding to AC.

Results

974 patients were eligible for analysis. 439 patients (45 %) had positive USFNAC and 535 (55 %) had a positive SLNB. USFNAC-positive patients were more likely to undergo mastectomy (Chi-square test; p < 0.001), have extra-nodal extension (p < 0.001), be oestrogen receptor negative (p < 0.001) and be HER2 positive (p < 0.001). The median total number of lymph nodes (LNs) excised during AC was higher in the USFNAC group (Mann–Whitney test; 23 vs. 21; p < 0.001). The median total number of involved LNs was 3 (range 1–47) in FNAC-positive patients versus 1 (range 1–37) in SLNB-positive patients (p < 0.001). The median number of involved LNs in level 1 was 3 in FNAC-positive patients versus 1 in SLNB-positive patients (p < 0.001). Within the SLN-positive group, 49 % of the patients had only one involved LN, 28 % had two nodes involved and 23 % had ≥3. In comparison, within the FNAC-positive group only 13 % of the patients had one involved LN, 12 % had two nodes involved and 74 % had ≥3.

Conclusion

Patients with positive USFNAC have more aggressive clinico-pathological characteristics and higher nodal burden compared to SLNB-positive patients. Currently, the authors advocate that patients not receiving neoadjuvant chemotherapy, with a positive USFNAC, should proceed directly to an axillary ALND.

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Authors and Affiliations

  1. The Department of Breast and Endocrine Surgery, St.Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    M. R. Boland, R. Ni Cearbhaill, K. Fitzpatrick, S. M. Walsh, D. Evoy, J. Geraghty, J. Rothwell, E. W. McDermott & R. S. Prichard

  2. The Department of Radiology, St.Vincent’s University Hospital, Dublin 4, Ireland

    S. McNally & A. O’Doherty

  3. The Department of Pathology, St.Vincent’s University Hospital, Dublin 4, Ireland

    C. M. Quinn

Authors
  1. M. R. Boland
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  2. R. Ni Cearbhaill
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  3. K. Fitzpatrick
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  4. S. M. Walsh
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  5. D. Evoy
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  6. J. Geraghty
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  7. J. Rothwell
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  8. S. McNally
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  9. A. O’Doherty
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  10. C. M. Quinn
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  11. E. W. McDermott
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  12. R. S. Prichard
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Correspondence to M. R. Boland.

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Additional information

This research was the first prize winner of the Breast Surgery International Free Paper at the BSI Annual Meeting/World Congress of Surgery, Bangkok in 2015.

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Boland, M.R., Ni Cearbhaill, R., Fitzpatrick, K. et al. A Positive Node on Ultrasound-Guided Fine Needle Aspiration Predicts Higher Nodal Burden Than a Positive Sentinel Lymph Node Biopsy in Breast Carcinoma. World J Surg 40, 2157–2162 (2016). https://doi.org/10.1007/s00268-016-3557-3

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  • DOI: https://doi.org/10.1007/s00268-016-3557-3

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