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Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management.

Sapino A, Cassoni P, Zanon E, Fraire F, Croce S, Coluccia C, Donadio M, Bussolati G - Br. J. Cancer (2003)

Bottom Line: In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN.Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination.This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Sciences and Human Oncology, University of Turin, Italy. anna.sapino@unito.it

ABSTRACT
The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the diagnosis of LN metastases and subsequently in the treatment of patients with breast cancer. Axillary US was performed in 298 patients with diagnosed breast cancer (267 invasive carcinomas and 31 ductal carcinoma in situ DCIS), and in 95 patients it was followed by FNAC of US suspicious LN. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry (ICC) with a combination of anticytokeratin and anti-HMFG2 antibodies. Eighty-five FNAC were informative (49 LN were positive for metastases, 36 were negative). In 49 of 267 patients with invasive breast carcinoma (18%), a preoperative diagnosis of metastatic LN in the axilla could be confirmed. These patients could proceed directly to axillary dissection. In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN. Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination. Based on these data, US examination should be performed in all patients with breast cancer adding ICC-supported FNAC only on US-suspect LN. This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.

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(A) Hematoxylin & Eosin stained smear of a US-guided FNAC in a selected axillary lymph node in breast cancer (×200 original magnification) (inset). (B) In a background of lymphocytes and red cells one large cell with hyperchromatic nucleus is evident (1000 × original magnification. (C), (D) The cocktail of antipancytokeratin and antiepithelial membrane antigen antibodies outlines numerous noncohesive metastatic cells of a lobular infiltrating carcinomas scattered among the lymphocytes (× 200 original magnification).
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fig2: (A) Hematoxylin & Eosin stained smear of a US-guided FNAC in a selected axillary lymph node in breast cancer (×200 original magnification) (inset). (B) In a background of lymphocytes and red cells one large cell with hyperchromatic nucleus is evident (1000 × original magnification. (C), (D) The cocktail of antipancytokeratin and antiepithelial membrane antigen antibodies outlines numerous noncohesive metastatic cells of a lobular infiltrating carcinomas scattered among the lymphocytes (× 200 original magnification).

Mentions: FNAC−=cytologically negative, FNAC+=cytologically positive, FNAC na=not adequate; N−=histologically negative, N+=histologically positive


Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management.

Sapino A, Cassoni P, Zanon E, Fraire F, Croce S, Coluccia C, Donadio M, Bussolati G - Br. J. Cancer (2003)

(A) Hematoxylin & Eosin stained smear of a US-guided FNAC in a selected axillary lymph node in breast cancer (×200 original magnification) (inset). (B) In a background of lymphocytes and red cells one large cell with hyperchromatic nucleus is evident (1000 × original magnification. (C), (D) The cocktail of antipancytokeratin and antiepithelial membrane antigen antibodies outlines numerous noncohesive metastatic cells of a lobular infiltrating carcinomas scattered among the lymphocytes (× 200 original magnification).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2376348&req=5

fig2: (A) Hematoxylin & Eosin stained smear of a US-guided FNAC in a selected axillary lymph node in breast cancer (×200 original magnification) (inset). (B) In a background of lymphocytes and red cells one large cell with hyperchromatic nucleus is evident (1000 × original magnification. (C), (D) The cocktail of antipancytokeratin and antiepithelial membrane antigen antibodies outlines numerous noncohesive metastatic cells of a lobular infiltrating carcinomas scattered among the lymphocytes (× 200 original magnification).
Mentions: FNAC−=cytologically negative, FNAC+=cytologically positive, FNAC na=not adequate; N−=histologically negative, N+=histologically positive

Bottom Line: In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN.Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination.This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Sciences and Human Oncology, University of Turin, Italy. anna.sapino@unito.it

ABSTRACT
The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the diagnosis of LN metastases and subsequently in the treatment of patients with breast cancer. Axillary US was performed in 298 patients with diagnosed breast cancer (267 invasive carcinomas and 31 ductal carcinoma in situ DCIS), and in 95 patients it was followed by FNAC of US suspicious LN. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry (ICC) with a combination of anticytokeratin and anti-HMFG2 antibodies. Eighty-five FNAC were informative (49 LN were positive for metastases, 36 were negative). In 49 of 267 patients with invasive breast carcinoma (18%), a preoperative diagnosis of metastatic LN in the axilla could be confirmed. These patients could proceed directly to axillary dissection. In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN. Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination. Based on these data, US examination should be performed in all patients with breast cancer adding ICC-supported FNAC only on US-suspect LN. This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.

Show MeSH
Related in: MedlinePlus