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Axillary Lymph Node Echo-Guided Fine-Needle Aspiration Cytology Enables Breast Cancer Patients to Avoid a Sentinel Lymph Node Biopsy. Preliminary Experience and a Review of the Literature

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Abstract

Purpose

For many years, the status of the axillary lymph nodes has been determined by an axillary lymphadenectomy. However, a sentinel lymph node biopsy has been shown to effectively replace the need for an axillary lymphadenectomy in order to determine the axillary staging. This study presents the preliminary results regarding the efficacy of fine-needle aspiration cytology (FNAC) to identify metastatic axillary lymph nodes in the pre-operative phase.

Methods

One hundred lymph nodes from 100 patients with histologically and cytologically confirmed breast cancer (cT1–2 cN0) underwent echo-guided FNAC. The diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) for the axillary metastases was evaluated based on the histological findings of either a sentinel lymph node biopsy or an axillary lymphadenectomy as a reference standard.

Results

It was possible to avoid a sentinel lymph node biopsy in 30% of the cases; the sensitivity was 68%, specificity 100%, PPV 100%, and NPV 65%. Echo-guided FNAC of the axillary lymph nodes should thus be included among the regular diagnostic procedures of presurgical staging.

Conclusion

This simple, inexpensive, and minimally invasive technique makes it possible to avoid the additional cost of a sentinel lymph node biopsy while also sparing the patient the stress of undergoing a second surgery.

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Authors and Affiliations

  1. Breast Unit, Campus Bio-Medico University, Rome, Italy

    Vittorio Altomare, Rita Carino, Angelo Primavera, Annamaria Altomare & Anna Maria Ferri

  2. Surgical Science Department, Policlinico Umberto I, “La Sapienza” University, Viale del Policlinico 155, 00161, Rome, Italy

    Gabriella Guerriero

  3. Department of Gynecology, Campus Bio-Medico University, Rome, Italy

    Cleonice Battista

  4. Department of Radiology, Campus Bio-Medico University, Rome, Italy

    Donata Vaccaro

  5. Department of Surgery, Campus Bio-Medico University, Rome, Italy

    Alessandro Esposito

  6. Department of Pathology, Campus Bio-Medico University, Rome, Italy

    Carla Rabitti

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  1. Vittorio Altomare
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Altomare, V., Guerriero, G., Carino, R. et al. Axillary Lymph Node Echo-Guided Fine-Needle Aspiration Cytology Enables Breast Cancer Patients to Avoid a Sentinel Lymph Node Biopsy. Preliminary Experience and a Review of the Literature. Surg Today 37, 735–739 (2007). https://doi.org/10.1007/s00595-006-3366-7

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  • DOI: https://doi.org/10.1007/s00595-006-3366-7

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