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Feasibility of fine‐needle aspiration for assessing responses to chemotherapy in metastatic nodes marked with clips in breast cancer: A prospective registry study
Author(s) -
Caudle Abigail S.,
Kuerer Henry M.,
Krishnamurthy Savitri,
Shin Kyungmin,
Hobbs Brian P.,
Ma Junsheng,
Mittendorf Elizabeth A.,
Washington Ashley C.,
DeSnyder Sarah M.,
Black Dalliah M.,
Hunt Kelly K.,
Yang Wei T.
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31825
Subject(s) - medicine , clips , metastatic breast cancer , chemotherapy , breast cancer , cancer , prospective cohort study , fine needle aspiration , surgery , general surgery , radiology , oncology , biopsy
Background Clips are often placed to mark axillary nodes with biopsy‐confirmed metastases in patients with breast cancer. The evaluation of clipped nodes after chemotherapy can identify patients who have eradication of nodal disease. The goal of this study was to determine whether preoperative fine‐needle aspiration (FNA) of clipped nodes after neoadjuvant chemotherapy (NAC) could predict the presence of residual disease. Methods This prospective registry study enrolled 50 patients with a clip placed to mark nodes with biopsy‐confirmed metastases who had completed NAC. Participants underwent FNA of the clipped node before seed‐localized lymph node excision. FNA pathology was compared with surgical pathology. Results There were 36 patients (72%) with residual disease on surgical pathology: 3 (8%) had a nondiagnostic aspirate, carcinoma was seen in 14 (39%), and 19 (53%) had a false‐negative result. The sensitivity of FNA was 42.4%, its specificity was 100%, and its negative predictive value was 40.6%. In a univariate analysis, the odds of a true‐positive result increased significantly with the mean initial size of the clipped node (odds ratio [OR], 4.3; P = .004) and the size of the metastatic focus after NAC (OR, 1.3; P = 0.003), whereas normalization of nodes after chemotherapy (OR, 0.1) and a lack of response on ultrasound (OR, 0.11) were associated with a false‐negative result ( P = .01). Conclusions FNA of marked nodes after chemotherapy has a high false‐negative rate. This highlights the need for surgical staging of the axilla after NAC to assess the response.