Sauer Torill, Kåresen Rolf
Address: Department of Pathology, Faculty of Medicine, Institute of Clinical Medicine, Akershus University Hospital and University of Oslo, Lørenskog, Norway.
Department of Breast and Endocrinological Surgery, Faculty of Medicine, Institute of Clinical Medicine, Oslo University Hospital Ulleval and University of Oslo, Oslo, Norway.
Cytojournal. 2014 Sep 26;11:26. doi: 10.4103/1742-6413.141820. eCollection 2014.
Preoperative ultrasound (US) and eventually US-guided fine-needle aspiration cytology (FNAC) of suspicious axillary lymph nodes (ALN) is a standard procedure in the work-up of suspicious breast lesions. Preoperative US FNAC may prevent sentinel node biopsy (SNB) procedure in 24-30% of patients with early stage breast carcinoma. The aim of this study was to evaluate the institutional results of this preoperative diagnostic procedure.
A total of 182 cases of preoperative FNAC of suspicious ALN where retrieved from the pathology files. The results were compared with the final histology and staging. False negative (FN) FNAC cases were reviewed and possibly missed metastatic cases (2) were immunostained with the epithelial marker AE1/AE3.
There were no false positives, whereas 16 cases were FN. In all but one case the FN's represented sampling error. Half of the 16 FN cases in this series were macrometastases.
About 83% of the preoperatively aspirated cases were N+, indicating that a radiologically suspicious ALN has a very high risk of being metastatic. Preoperative US guided FNAC from radiologically suspicious ALN is highly efficient in detecting metastases. Depending on national guidelines, a preoperative, positive ALN FNAC might help to stratify the patients as to SNB and/or ALN dissection.
术前超声（US）以及最终对可疑腋窝淋巴结（ALN）进行超声引导下细针穿刺细胞学检查（FNAC）是对可疑乳腺病变进行检查的标准程序。术前US FNAC可使24% - 30%的早期乳腺癌患者避免前哨淋巴结活检（SNB）程序。本研究的目的是评估这一术前诊断程序在本机构的结果。
从病理档案中检索出182例术前对可疑ALN进行FNAC的病例。将结果与最终组织学和分期进行比较。对假阴性（FN）FNAC病例进行复查，并对可能漏诊的转移病例（2例）用上皮标志物AE1/AE3进行免疫染色。
无假阳性病例，而有16例假阴性病例。除1例病例外，其余所有FN病例均为抽样误差。本系列16例FN病例中有一半为大转移灶。
术前抽吸病例中约83%为N +，表明放射学上可疑的ALN发生转移的风险非常高。术前对放射学上可疑的ALN进行US引导下FNAC在检测转移方面效率很高。根据国家指南，术前ALN FNAC结果为阳性可能有助于对患者进行SNB和/或腋窝淋巴结清扫的分层。
