{"title":"腋窝淋巴结细针穿刺细胞学检查在早期乳腺癌伴或不伴新辅助化疗中的作用评价。","authors":"Daiki Takatsuka, Akiyo Yoshimura, Masataka Sawaki, Masaya Hattori, Haruru Kotani, Ayumi Kataoka, Nanae Horisawa, Yuri Ozaki, Yuka Endo, Kazuki Nozawa, Hiroji Iwata","doi":"10.4048/jbc.2023.26.e13","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Fine-needle aspiration cytology (FNAC) of axillary lymph nodes (AxLNs) is performed to diagnose nodal metastasis in patients with breast cancer. Although the sensitivity of ultrasound-guided FNAC for identifying AxLN metastasis is in the range of 36%-99%, whether sentinel lymph node biopsy (SLNB) should be performed for neoadjuvant chemotherapy (NAC) patients with negative FNAC results is uncertain. This study aimed to determine the role of FNAC before NAC in the evaluation and management of AxLN in early breast cancer patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 3,810 clinically node-negative (a lymph node with no clinical metastasis without FNAC or radiological suspicion of metastasis with negative FNAC results) patients with breast cancer who underwent SLNB between 2008 and 2019. We compared the positivity rate of sentinel lymph nodes (SLNs) between patients who received and those who did not receive NAC with negative FNAC results or without FNAC and axillary recurrence rate in the neoadjuvant group with negative SLNB results.</p><p><strong>Results: </strong>In the non-neoadjuvant (primary surgery) group, the positivity rate of SLNs in patients with negative FNAC results was higher than that in patients without FNAC (33.2% vs. 12.9%; <i>p</i> < 0.001). However, the SLN positivity rate of patients with negative FNAC results (false-negative rate for FNAC) in the neoadjuvant group was lower than that in the primary surgery group (3.0% vs. 33.2%; <i>p</i> < 0.001). After a median follow-up of 3 years, one axillary nodal recurrence was observed, which was a case from the neoadjuvant non-FNAC group. None of the patients in the neoadjuvant group with negative FNAC results had axillary recurrence.</p><p><strong>Conclusion: </strong>The false-negative rate for FNAC in the primary surgery group was high; however, SLNB was the proper axillary staging procedure for NAC patients who have clinically suspicious AxLN metastases on radiologic examination but negative FNAC results.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":"26 2","pages":"117-125"},"PeriodicalIF":2.2000,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c3/54/jbc-26-117.PMC10139842.pdf","citationCount":"1","resultStr":"{\"title\":\"Evaluation of the Role of Axillary Lymph Node Fine-Needle Aspiration Cytology in Early Breast Cancer With or Without Neoadjuvant Chemotherapy.\",\"authors\":\"Daiki Takatsuka, Akiyo Yoshimura, Masataka Sawaki, Masaya Hattori, Haruru Kotani, Ayumi Kataoka, Nanae Horisawa, Yuri Ozaki, Yuka Endo, Kazuki Nozawa, Hiroji Iwata\",\"doi\":\"10.4048/jbc.2023.26.e13\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Fine-needle aspiration cytology (FNAC) of axillary lymph nodes (AxLNs) is performed to diagnose nodal metastasis in patients with breast cancer. Although the sensitivity of ultrasound-guided FNAC for identifying AxLN metastasis is in the range of 36%-99%, whether sentinel lymph node biopsy (SLNB) should be performed for neoadjuvant chemotherapy (NAC) patients with negative FNAC results is uncertain. This study aimed to determine the role of FNAC before NAC in the evaluation and management of AxLN in early breast cancer patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 3,810 clinically node-negative (a lymph node with no clinical metastasis without FNAC or radiological suspicion of metastasis with negative FNAC results) patients with breast cancer who underwent SLNB between 2008 and 2019. We compared the positivity rate of sentinel lymph nodes (SLNs) between patients who received and those who did not receive NAC with negative FNAC results or without FNAC and axillary recurrence rate in the neoadjuvant group with negative SLNB results.</p><p><strong>Results: </strong>In the non-neoadjuvant (primary surgery) group, the positivity rate of SLNs in patients with negative FNAC results was higher than that in patients without FNAC (33.2% vs. 12.9%; <i>p</i> < 0.001). However, the SLN positivity rate of patients with negative FNAC results (false-negative rate for FNAC) in the neoadjuvant group was lower than that in the primary surgery group (3.0% vs. 33.2%; <i>p</i> < 0.001). After a median follow-up of 3 years, one axillary nodal recurrence was observed, which was a case from the neoadjuvant non-FNAC group. None of the patients in the neoadjuvant group with negative FNAC results had axillary recurrence.</p><p><strong>Conclusion: </strong>The false-negative rate for FNAC in the primary surgery group was high; however, SLNB was the proper axillary staging procedure for NAC patients who have clinically suspicious AxLN metastases on radiologic examination but negative FNAC results.</p>\",\"PeriodicalId\":15206,\"journal\":{\"name\":\"Journal of Breast Cancer\",\"volume\":\"26 2\",\"pages\":\"117-125\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2023-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c3/54/jbc-26-117.PMC10139842.pdf\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Breast Cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4048/jbc.2023.26.e13\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Breast Cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4048/jbc.2023.26.e13","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 1
摘要
目的:对乳腺癌患者腋窝淋巴结(AxLNs)进行细针穿刺细胞学检查(FNAC)诊断淋巴结转移。虽然超声引导下FNAC识别AxLN转移的敏感性在36%-99%之间，但对于FNAC阴性的新辅助化疗(NAC)患者是否应进行前哨淋巴结活检(SLNB)尚不确定。本研究旨在确定NAC前FNAC在早期乳腺癌患者AxLN的评估和管理中的作用。方法:回顾性分析2008年至2019年期间3810例临床淋巴结阴性(无临床转移的淋巴结，无FNAC或影像学怀疑转移，FNAC阴性结果)的乳腺癌SLNB患者。我们比较了接受和未接受NAC且FNAC阴性或未接受NAC的患者的前哨淋巴结(sln)阳性率以及新辅助组中SLNB阴性的腋窝复发率。结果:在非新辅助(原发性手术)组中，FNAC阴性患者的sln阳性率高于无FNAC患者(33.2% vs 12.9%;P < 0.001)。然而，新辅助组FNAC阴性患者的SLN阳性率(FNAC假阴性率)低于原发性手术组(3.0% vs. 33.2%;P < 0.001)。中位随访3年后，观察到1例腋窝淋巴结复发，这是新辅助非fnac组的1例。新辅助组中FNAC阴性的患者没有腋窝复发。结论:原发性手术组FNAC假阴性率较高;然而，对于在影像学检查中有临床可疑AxLN转移但FNAC阴性的NAC患者，SLNB是合适的腋窝分期方法。
Evaluation of the Role of Axillary Lymph Node Fine-Needle Aspiration Cytology in Early Breast Cancer With or Without Neoadjuvant Chemotherapy.
Purpose: Fine-needle aspiration cytology (FNAC) of axillary lymph nodes (AxLNs) is performed to diagnose nodal metastasis in patients with breast cancer. Although the sensitivity of ultrasound-guided FNAC for identifying AxLN metastasis is in the range of 36%-99%, whether sentinel lymph node biopsy (SLNB) should be performed for neoadjuvant chemotherapy (NAC) patients with negative FNAC results is uncertain. This study aimed to determine the role of FNAC before NAC in the evaluation and management of AxLN in early breast cancer patients.
Methods: We retrospectively analyzed 3,810 clinically node-negative (a lymph node with no clinical metastasis without FNAC or radiological suspicion of metastasis with negative FNAC results) patients with breast cancer who underwent SLNB between 2008 and 2019. We compared the positivity rate of sentinel lymph nodes (SLNs) between patients who received and those who did not receive NAC with negative FNAC results or without FNAC and axillary recurrence rate in the neoadjuvant group with negative SLNB results.
Results: In the non-neoadjuvant (primary surgery) group, the positivity rate of SLNs in patients with negative FNAC results was higher than that in patients without FNAC (33.2% vs. 12.9%; p < 0.001). However, the SLN positivity rate of patients with negative FNAC results (false-negative rate for FNAC) in the neoadjuvant group was lower than that in the primary surgery group (3.0% vs. 33.2%; p < 0.001). After a median follow-up of 3 years, one axillary nodal recurrence was observed, which was a case from the neoadjuvant non-FNAC group. None of the patients in the neoadjuvant group with negative FNAC results had axillary recurrence.
Conclusion: The false-negative rate for FNAC in the primary surgery group was high; however, SLNB was the proper axillary staging procedure for NAC patients who have clinically suspicious AxLN metastases on radiologic examination but negative FNAC results.
期刊介绍：
The Journal of Breast Cancer (abbreviated as ''J Breast Cancer'') is the official journal of the Korean Breast Cancer Society, which is issued quarterly in the last day of March, June, September, and December each year since 1998. All the contents of the Journal is available online at the official journal website (http://ejbc.kr) under open access policy. The journal aims to provide a forum for the academic communication between medical doctors, basic science researchers, and health care professionals to be interested in breast cancer. To get this aim, we publish original investigations, review articles, brief communications including case reports, editorial opinions on the topics of importance to breast cancer, and welcome new research findings and epidemiological studies, especially when they contain a regional data to grab the international reader''s interest. Although the journal is mainly dealing with the issues of breast cancer, rare cases among benign breast diseases or evidence-based scientifically written articles providing useful information for clinical practice can be published as well.
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