Yasuharu Nakano1, Masakuni Noguchi2, Miki Yokoi-Noguchi1, Yukako Ohno1, Emi Morioka1, Takeo Kosaka3, Tomoko Takahashi4, Hiroshi Minato5. 1. Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan. 2. Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan. nogumasa@kanazawa-med.ac.jp. 3. Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan. 4. Department of Radiology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan. 5. Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
Abstract
BACKGROUND: There is a need for less invasive techniques for preoperative identification of axillary lymph node (ALN) metastases. METHOD: Patients underwent ultrasonography (US) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT), and then US-guided fine needle aspiration cytology (FNAC) and/or sentinel lymph node (SLN) biopsy were performed based on the US findings of the ALNs. Subsequently, patients with positive FNAC as well as those with positive SLN underwent axillary lymph node dissection (ALND). Postoperatively, removed SLNs and ALNs were examined histologically. RESULTS: Fifty (85 %) of 59 patients with positive 18F-FDG uptake in the axilla had axillary metastases, but 18F-FDG uptake results were false-positive in 9 (15 %) cases. On the other hand, 29 patients with positive FNAC underwent ALND without the need for SLN biopsy, while the remaining 20 patients with negative FNAC as well as 249 patients with negative US findings underwent SLN biopsy. Subsequently, 68 patients with positive SLN underwent ALND. CONCLUSIONS: Positive FDG uptake in the axilla does not always indicate axillary metastasis. US-guided FNAC is useful to avoid unnecessary ALND in patients with positive 18F-FDG uptake. However, SLN biopsy is needed in patients with negative US findings of the ALNs and those with negative FNAC.
BACKGROUND: There is a need for less invasive techniques for preoperative identification of axillary lymph node (ALN) metastases. METHOD:Patients underwent ultrasonography (US) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT), and then US-guided fine needle aspiration cytology (FNAC) and/or sentinel lymph node (SLN) biopsy were performed based on the US findings of the ALNs. Subsequently, patients with positive FNAC as well as those with positive SLN underwent axillary lymph node dissection (ALND). Postoperatively, removed SLNs and ALNs were examined histologically. RESULTS: Fifty (85 %) of 59 patients with positive 18F-FDG uptake in the axilla had axillary metastases, but 18F-FDG uptake results were false-positive in 9 (15 %) cases. On the other hand, 29 patients with positive FNAC underwent ALND without the need for SLN biopsy, while the remaining 20 patients with negative FNAC as well as 249 patients with negative US findings underwent SLN biopsy. Subsequently, 68 patients with positive SLN underwent ALND. CONCLUSIONS: Positive FDG uptake in the axilla does not always indicate axillary metastasis. US-guided FNAC is useful to avoid unnecessary ALND in patients with positive 18F-FDG uptake. However, SLN biopsy is needed in patients with negative US findings of the ALNs and those with negative FNAC.
Entities:
Keywords:
Axillary lymph node metastasis; Breast cancer; Fine needle aspiration cytology; Positron emission tomography
Authors: Almir Bitencourt; Carolina Rossi Saccarelli; Elizabeth A Morris; Jessica Flynn; Zhigang Zhang; Atif Khan; Erin Gillespie; Oren Cahlon; Boris Mueller; John J Cuaron; Beryl McCormick; Simon N Powell; George Plitas; Pedram Razavi; Katja Pinker; Christopher C Riedl; Elizabeth J Sutton; Lior Z Braunstein Journal: JAMA Netw Open Date: 2020-10-01