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
Department of Pathology, S. Antonio e Biagio Hospital, Alessandria (AL), Italy.
Department of Pathology, ASL4 Chiavarese General Hospital, Chiavari (GE), Italy.
Diagn Cytopathol. 2018 Nov;46(11):919-926. doi: 10.1002/dc.23995. Epub 2018 Oct 24.
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.
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.
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).
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.
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.
前哨淋巴结活检（SLNB）已成为乳腺癌分期的标准方法，但成本高且耗时。超声引导下细针穿刺细胞学检查（FNAC）可识别需要进行腋窝淋巴结清扫术（ALND）的患者，从而降低成本。作为冰冻切片（FS）的替代方法，用于前哨淋巴结活检的术中刮片细胞学检查（ISC）是一种廉价、快速、准确且安全的技术。我们评估了FNAC和SLNB在确定腋窝病变情况方面的协同作用以及ISC方法的性能。
在九年时间里，对894例乳腺癌患者进行了分析。其中，439例超声检查怀疑有淋巴结转移的患者接受了术前FNAC；腋窝超声检查或FNAC结果为阴性的606例患者接受了术中SLNB，采用ISC技术进行。将结果与组织学诊断进行比较，并计算敏感性、特异性、预测值和准确性。
在439例FNAC检查中，121例为阳性并立即进行了ALND，242例阴性患者接受了术中SLNB（敏感性为69%，特异性为99%）。阳性病例通常有多个淋巴结受累（55%为pN2 - 3）。在606例SLNB - ISC涂片检查中，510例为真阴性；65例真阳性允许进行一步ALND（敏感性为71%，特异性为99%）。
术前腋窝FNAC阳性预示着更高的疾病负担，并确定了对于适合立即进行ALND的患者可避免进行SLNB。ISC而非FS是一种识别转移灶的安全且敏感的技术，表明ALND已完成。
2013年5月27 - 29日在美国加利福尼亚州旧金山举行的联合国际肿瘤学（前哨淋巴结与癌症转移）大会；2013年5月26 - 30日在法国巴黎举行的第18届国际细胞学大会（ICC 2013 - 1161）；2016年5月19 - 20日在意大利萨沃纳举行的意大利国家GISMa会议 - 菲纳博尔戈会议。
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