Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA.
Division of Clinical Trials and Biostatistics, Mayo Clinic Rochester, Rochester, MN, USA.
Ann Surg Oncol. 2022 Oct;29(10):6276-6287. doi: 10.1245/s10434-022-12131-w. Epub 2022 Jul 19.
Fine needle aspiration (FNA) of sonographically suspicious axillary lymph nodes is helpful to clinically stage patients and guide consideration of neoadjuvant therapy in breast cancer. However, data are limited for suspicious nodes that are FNA negative. Our goal is to compare the frequency of node positivity between patients with negative axillary ultrasound (AUSneg) versus suspicious AUS with negative FNA (FNAneg).
With IRB approval, we identified all clinically node-negative (cN0) patients with invasive breast cancer treated with upfront surgery at our tertiary care center between 2016 and 2021. AUS is routinely performed with FNA of suspicious lymph node(s). We compared clinicopathologic characteristics and nodal positivity rates between AUSneg and FNAneg groups.
A total of 1580 cN0 patients with invasive breast cancer were analyzed, including 1240 AUSneg and 340 FNAneg patients. The FNAneg group was younger (median age 59.7 years versus 63.5 years, p < 0.001) and had higher clinical T (cT) category (29.1% versus 21.7% with cT2-cT4 disease, p = 0.005). Final axillary pathologic node positivity did not differ significantly between the AUSneg and FNAneg groups (16.5% versus 19.1%, p = 0.25). Among FNAneg patients, 58/340 (17.1%) had a clip placed, with retrieval confirmed in 28/58 (48.3%). Of the 28 retrieved clipped nodes, 27 were sentinel nodes. Final pathologic nodal status (pN+%) did not differ between patients in whom retrieval of the clipped node was confirmed versus not confirmed (28.6% versus 16.7%, p = 0.28).
Both patients with sonographically suspicious node(s) and negative FNA and patients with negative AUS have a similarly low chance of positive nodes. Additionally, routine targeted excision of FNA-negative clipped nodes is not warranted.
超声检查可疑的腋窝淋巴结细针穿刺（FNA）有助于对患者进行临床分期，并指导乳腺癌新辅助治疗的考虑。然而，对于 FNA 阴性的可疑淋巴结，数据有限。我们的目标是比较超声检查阴性（AUSneg）与可疑超声检查且 FNA 阴性（FNAneg）的腋窝淋巴结阳性率。
在获得机构审查委员会批准后，我们在 2016 年至 2021 年间，确定了所有在我们的三级保健中心接受初始手术治疗的浸润性乳腺癌且临床淋巴结阴性（cN0）患者。常规进行可疑淋巴结的 FNA 超声检查。我们比较了 AUSneg 和 FNAneg 组的临床病理特征和淋巴结阳性率。
共分析了 1580 例浸润性乳腺癌 cN0 患者，其中 1240 例为 AUSneg，340 例为 FNAneg。FNAneg 组年龄较小（中位年龄 59.7 岁 vs. 63.5 岁，p < 0.001），临床 T 分期更高（29.1% vs. 21.7%为 cT2-cT4 疾病，p = 0.005）。AUSneg 和 FNAneg 组的最终腋窝病理淋巴结阳性率无显著差异（16.5% vs. 19.1%，p = 0.25）。在 FNAneg 患者中，58/340（17.1%）放置了夹，其中 28/58（48.3%）夹取物得到了确认。在 28 个取回的夹取物中，27 个为前哨淋巴结。在确认或未确认夹取物取回的患者中，最终病理淋巴结状态（pN+%）无差异（28.6% vs. 16.7%，p = 0.28）。
超声检查可疑淋巴结和 FNA 阴性的患者与 AUS 阴性的患者一样，淋巴结阳性的可能性均较低。此外，常规靶向切除 FNA 阴性的夹取物是没有必要的。
