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HER2 expression in fine needle aspirates of lymph nodes detected by preoperative axillary ultrasound in breast cancer patients.

Choi JS, Kim HO, Kim EK, Suh YJ, Yoon JH, Moon HJ, Kim MJ - PLoS ONE (2014)

Bottom Line: The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis.In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P = 0.04).Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea; Department of Radiology, Samsung Medical Center, Seoul, Korea.

ABSTRACT
The purpose of this study was to assess the usefulness of HER2 levels in ultrasonographically guided fine-needle aspiration biopsy (US-FNA) aspirates of axillary lymph nodes (ALNs) in the determination of lymph node metastasis or the characterization of primary breast cancer, and to correlate the HER2 levels in US-FNA aspirates (FNA-HER2s) of metastatic ALNs with the HER2 statuses of corresponding primary breast cancers. An institutional review board approved the study. Between January and October 2010, 164 patients with 167 ALNs examined by US-FNA were included. FNA-HER2s of ALNs were measured by chemiluminescence immunoassay, and they were correlated with cytologic/final diagnoses. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the diagnostic ability to differentiate benign and metastatic ALNs. Additionally, FNA-HER2s of metastatic ALNs were correlated with HER2 status and other clinicopathologic variables of the primary breast cancers. Among the 167 ALNs, 138 were metastatic and 29 were benign. The mean FNA-HER2 (6.3 ng/ml) of metastatic ALNs was higher than that of benign ALNs. All 29 benign ALNs showed no measurable value of FNA-HER2 (0.0 ng/ml). The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis. The FNA-HER2 statuses of 108 metastatic ALNs (79.4%) were concordant with the HER2 statuses of the corresponding primary breast cancers. In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P = 0.04). Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers. Additionally, FNA-HER2 analysis of ALN may help to develop more personalized treatment protocol for breast cancer patients by determining the concordance or discordance of HER2 status between primary cancers and metastatic ALNs.

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FNA-HER2 of 167 axillary lymph nodes in 165 invasive breast cancers.
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pone-0113065-g001: FNA-HER2 of 167 axillary lymph nodes in 165 invasive breast cancers.

Mentions: Of the 167 ALNs, 138 (82.6%) were metastatic and 29 (17.4%) were benign according to reference standards. The 138 metastatic nodes were confirmed by surgery (n = 116) or with both clinical evidence and cytologic results (n = 22), due to the presence of distant metastasis. The cytology results from US-FNA of ALNs in final metastatic nodes were: metastatic in 125 (74.9%), and benign in 13 nodes (11 benign and 2 insufficient). All 29 of the finally benign nodes had benign cytologic results (27 benign and 2 insufficient material for diagnosis). All 13 of the metastatic ALNs yielding negative cytologic results had negative results (0.00 ng/mL) by FNA-HER2 analysis. The 29 benign ALNs also had no measurable value of HER2. Of the 138 metastatic ALNs, 52 ALNs (37.7%) had positive results (>0.00 ng/mL) by FNA-HER2 analysis. The mean FNA-HER2 (mean 6.31, range 0–154.60) of the metastatic ALNs was higher than that of the benign ALNs, although a substantial number of metastatic ALNs (86/138) had negative results by FNA-HER2 analysis (Figure 1). The area under the ROC curves (Az value) of FNA-HER2s of ALNs was 0.679 for the diagnosis of ALN metastasis, and the optimal cut-off level was 0.00 ng/mL (sensitivity 37.7%, specificity 100%), while the Az value of US-FNA cytology was 0.953 (sensitivity 90.6%, specificity 100%). Addition of FNA-HER2 to the US-FNA cytologic results did not improve the Az value for the prediction of ALN metastasis. In subgroup ROC analysis of 59 patients with HER2-positive primary breast cancers, the Az value of FNA-HER2 was 0.865, and the optimal cut-off level was 0.00 ng/mL (sensitivity 73.1%, specificity 100%) for the diagnosis of ALN metastasis. In this subgroup, the Az value of US-FNA cytology (0.981) was also significantly higher than that of FNA-HER2 (P = 0.04).


HER2 expression in fine needle aspirates of lymph nodes detected by preoperative axillary ultrasound in breast cancer patients.

Choi JS, Kim HO, Kim EK, Suh YJ, Yoon JH, Moon HJ, Kim MJ - PLoS ONE (2014)

FNA-HER2 of 167 axillary lymph nodes in 165 invasive breast cancers.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231107&req=5

pone-0113065-g001: FNA-HER2 of 167 axillary lymph nodes in 165 invasive breast cancers.
Mentions: Of the 167 ALNs, 138 (82.6%) were metastatic and 29 (17.4%) were benign according to reference standards. The 138 metastatic nodes were confirmed by surgery (n = 116) or with both clinical evidence and cytologic results (n = 22), due to the presence of distant metastasis. The cytology results from US-FNA of ALNs in final metastatic nodes were: metastatic in 125 (74.9%), and benign in 13 nodes (11 benign and 2 insufficient). All 29 of the finally benign nodes had benign cytologic results (27 benign and 2 insufficient material for diagnosis). All 13 of the metastatic ALNs yielding negative cytologic results had negative results (0.00 ng/mL) by FNA-HER2 analysis. The 29 benign ALNs also had no measurable value of HER2. Of the 138 metastatic ALNs, 52 ALNs (37.7%) had positive results (>0.00 ng/mL) by FNA-HER2 analysis. The mean FNA-HER2 (mean 6.31, range 0–154.60) of the metastatic ALNs was higher than that of the benign ALNs, although a substantial number of metastatic ALNs (86/138) had negative results by FNA-HER2 analysis (Figure 1). The area under the ROC curves (Az value) of FNA-HER2s of ALNs was 0.679 for the diagnosis of ALN metastasis, and the optimal cut-off level was 0.00 ng/mL (sensitivity 37.7%, specificity 100%), while the Az value of US-FNA cytology was 0.953 (sensitivity 90.6%, specificity 100%). Addition of FNA-HER2 to the US-FNA cytologic results did not improve the Az value for the prediction of ALN metastasis. In subgroup ROC analysis of 59 patients with HER2-positive primary breast cancers, the Az value of FNA-HER2 was 0.865, and the optimal cut-off level was 0.00 ng/mL (sensitivity 73.1%, specificity 100%) for the diagnosis of ALN metastasis. In this subgroup, the Az value of US-FNA cytology (0.981) was also significantly higher than that of FNA-HER2 (P = 0.04).

Bottom Line: The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis.In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P = 0.04).Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea; Department of Radiology, Samsung Medical Center, Seoul, Korea.

ABSTRACT
The purpose of this study was to assess the usefulness of HER2 levels in ultrasonographically guided fine-needle aspiration biopsy (US-FNA) aspirates of axillary lymph nodes (ALNs) in the determination of lymph node metastasis or the characterization of primary breast cancer, and to correlate the HER2 levels in US-FNA aspirates (FNA-HER2s) of metastatic ALNs with the HER2 statuses of corresponding primary breast cancers. An institutional review board approved the study. Between January and October 2010, 164 patients with 167 ALNs examined by US-FNA were included. FNA-HER2s of ALNs were measured by chemiluminescence immunoassay, and they were correlated with cytologic/final diagnoses. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the diagnostic ability to differentiate benign and metastatic ALNs. Additionally, FNA-HER2s of metastatic ALNs were correlated with HER2 status and other clinicopathologic variables of the primary breast cancers. Among the 167 ALNs, 138 were metastatic and 29 were benign. The mean FNA-HER2 (6.3 ng/ml) of metastatic ALNs was higher than that of benign ALNs. All 29 benign ALNs showed no measurable value of FNA-HER2 (0.0 ng/ml). The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis. The FNA-HER2 statuses of 108 metastatic ALNs (79.4%) were concordant with the HER2 statuses of the corresponding primary breast cancers. In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P = 0.04). Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers. Additionally, FNA-HER2 analysis of ALN may help to develop more personalized treatment protocol for breast cancer patients by determining the concordance or discordance of HER2 status between primary cancers and metastatic ALNs.

Show MeSH
Related in: MedlinePlus