Optimising Axillary Staging in Resource-Constrained Settings: A Prospective Validation of Axillary Ultrasound and Touch Imprint Cytology in Predicting Pathologically Negative Axillae in cT2-3 Breast Cancer

IF 1.1 4区医学 Q4 CELL BIOLOGY

Cytopathology Pub Date : 2025-03-27 DOI:10.1111/cyt.13484

Balmik Chaturvedi, Muktesh Khandare, Devashish Mishra, Sanjay Kumar Yadav, Pawan Agarwal, Dhananjaya Sharma

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Abstract

Background

Management of axillary lymph nodes (ALNs) in breast cancer patients remains pivotal for staging and planning therapeutic strategies. However, In low-resource settings, achieving accurate axillary staging while avoiding overtreatment remains a challenge as the majority of patients present with advanced stage. In this prospective validation study, we assessed the efficacy of axillary ultrasound (AUS) combined with touch imprint cytology (TIC) for predicting negative axillary status in cT2-3 breast cancer patients.

Methods

This study was a prospective, single-centre validation study conducted in the Breast and Endocrine Unit of the Department of Surgery and the Department of Pathology in a tertiary teaching hospital in central India from September 2022 to April 2024. Eligible participants included adult female patients (aged ≥ 18 years) with core needle biopsy-proven invasive breast cancer classified as cT2-3, cN0, and scheduled for primary surgical treatment. The primary outcomes were the Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the AUS + TIC approach in predicting pathologically negative axillary status.

Results

AUS + TIC had a sensitivity of 100% (95% CI: 47.82%–100%), a specificity of 100% (95% CI: 91.19%–100%) and an overall accuracy of 100% (95% CI: 92.13%–100%). There were no false negatives.

Conclusion

Our findings suggest that the combination of AUS + TIC provides a reliable technique with high diagnostic accuracy, sensitivity, and specificity for assessing ALN in low resource settings.

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在资源受限的环境下优化腋窝分期：腋窝超声和触摸印迹细胞学预测cT2-3乳腺癌病理阴性腋窝的前瞻性验证。

背景：乳腺癌患者腋窝淋巴结（aln）的管理仍然是分期和规划治疗策略的关键。然而，在资源匮乏的环境中，由于大多数患者已进入晚期，在避免过度治疗的同时实现准确的腋窝分期仍然是一个挑战。在这项前瞻性验证研究中，我们评估了腋窝超声（AUS）联合触摸印记细胞学（TIC）预测cT2-3乳腺癌患者腋窝阴性状态的有效性。方法：本研究是一项前瞻性单中心验证研究，于2022年9月至2024年4月在印度中部一家三级教学医院的外科和病理学乳腺和内分泌科进行。符合条件的参与者包括成年女性患者（年龄≥18岁），核心针活检证实浸润性乳腺癌，分类为cT2-3， cN0，并计划进行初级手术治疗。主要结果为AUS + TIC入路预测腋窝病理阴性状态的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。结果：AUS + TIC的敏感性为100% (95% CI: 47.82% ~ 100%)，特异性为100% (95% CI: 91.19% ~ 100%)，总体准确度为100% （95% CI: 92.13% ~ 100%）。没有假阴性。结论：我们的研究结果表明，联合AUS + TIC为低资源环境下评估ALN提供了一种可靠的技术，具有较高的诊断准确性、敏感性和特异性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cytopathology 生物-病理学

CiteScore

2.30

自引率

15.40%

发文量

107

审稿时长

6-12 weeks

期刊介绍： The aim of Cytopathology is to publish articles relating to those aspects of cytology which will increase our knowledge and understanding of the aetiology, diagnosis and management of human disease. It contains original articles and critical reviews on all aspects of clinical cytology in its broadest sense, including: gynaecological and non-gynaecological cytology; fine needle aspiration and screening strategy. Cytopathology welcomes papers and articles on: ultrastructural, histochemical and immunocytochemical studies of the cell; quantitative cytology and DNA hybridization as applied to cytological material.