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Synergy of cytological methods in the pathological staging of breast cancer: Axillary fine‐needle aspiration and intraoperative scrape cytology of the sentinel lymph node
Author(s) -
Bruzzone Martina,
Saro Francesca,
Bruno Sara,
Celiento Tiziana,
Mazzarella Giovanna,
Lanata Sergio,
Aquilano Maria Costanza,
Parmigiani Gianpietro,
Pollone Massimo,
Gandolfo Fabrizio,
Costigliolo Giovanni,
Sironi Maria
Publication year - 2018
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.23995
Subject(s) - medicine , sentinel lymph node , axillary lymph node dissection , breast cancer , biopsy , radiology , sentinel node , lymph node , surgery , fine needle aspiration cytology , cytology , cancer , pathology
Background Sentinel lymph node biopsy (SLNB) has become the standard in breast cancer staging, but it is costly and time‐consuming. Fine‐needle aspiration cytology (FNAC) under ultrasonographic guidance identifies patients who need axillary lymph‐node dissection (ALND), thus reducing costs. As an alternative to frozen sections (FS), intraoperative scrape cytology (ISC) for SLNB is an inexpensive, rapid, accurate and safe technique. We evaluated the synergy of FNAC and SLNB in determining the axillary burden and the performance of the ISC method. Methods Over a nine‐year period, 894 breast cancer patients were analyzed. Of these, 439 patients with echographic suspicious nodes underwent preoperative FNAC; negative axillary ultrasounds or FNACs resulted in 606 intraoperative SLNB, performed using the ISC technique. The results were compared with histological diagnosis, and sensitivity, specificity, predictive values and accuracy were calculated. Results Of the 439 FNACs, 121 were positive and underwent immediate ALND, and 242 negative patients underwent intraoperative SLNB (69% sensitivity, 99% specificity). Positive cases often had multiple nodal involvement (55% pN2‐3). Of the 606 SLNB‐ISC smears, 510 were true negative; 65 true positives allowed for one‐step ALND (71% sensitivity, 99% specificity). Conclusion Preoperative positive axillary FNAC predicts a higher disease burden and determines the avoidance of SLNB for patients eligible for immediate ALND. ISC instead of FS is a safe and sensitive technique to identify metastases, indicating completion of ALND.Partially presented at Joint International Oncology (sentinel node & cancer metastasis) Congress, May 27‐29, 2013, San Francisco, California, USA 18 ° International Congress of Cytology (ICC 2013‐1161), May 26‐30, 2013, Paris, France Convegno Nazionale GISMa ‐ Finalborgo (Savona), Italy,19‐20 maggio 2016