Department of Pathology and Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia.
Breast Imaging Department, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia.
Cancer Cytopathol. 2024 Feb;132(2):103-108. doi: 10.1002/cncy.22770. Epub 2023 Oct 16.
Pathologic evaluation of sentinel lymph node biopsy (SLNB) samples is crucial for axillary staging in patients newly diagnosed with breast cancer. Patients with pathologic evidence of nodal metastasis scheduled for upfront surgery typically also undergo axillary lymph node dissection (ALND). Although SLNB is the gold standard method for detecting nodal metastasis, axillary lymph node fine-needle aspiration biopsy (FNAB) utility has not been thoroughly explored.
Ultrasound-guided axillary lymph node FNAB samples along with concurrent ipsilateral breast tissue samples were searched and reviewed. The control group included histologic findings of axillary dissection or intraoperative SLNB results.
A total of 354 axillary lymph node FNAB samples with matched histology were included. Of these, 187 (52.8%) were positive for metastatic carcinoma of breast origin; 143 (40.4%) were negative for metastasis; 12 (3.4%) showed atypical cells; six (1.7%) were suspicious for metastasis; and six (1.7%) were nondiagnostic because of a lack of lymphoid tissue and malignant cells. Of the 143 negative FNAB samples, 22 (15.4%) were positive on either intraoperative SLNB or ALND. When only the positive and negative FNAB samples were accounted for (n = 330; 93.2%), overall diagnostic sensitivity and specificity were 89.4% and 99.2%, respectively.
Although axillary SLNB is the standard procedure for detecting nodal metastasis of breast origin, axillary lymph node FNAB appears to be a suitable alternative in a significant proportion of patients. A standard SLNB should be performed in cases of negative axillary lymph node FNAB findings, particularly nodes with abnormal imaging findings.
对于新诊断为乳腺癌的患者，前哨淋巴结活检（SLNB）样本的病理评估对于腋窝分期至关重要。有病理证据表明存在淋巴结转移的患者，通常会进行前哨淋巴结清扫术（ALND）。尽管 SLNB 是检测淋巴结转移的金标准方法，但尚未彻底探讨细针抽吸活检（FNAB）在腋窝淋巴结中的应用。
对超声引导下的腋窝淋巴结 FNAB 样本及同时进行的同侧乳腺组织样本进行了搜索和回顾。对照组包括腋窝解剖或术中 SLNB 结果的组织学发现。
共纳入 354 例腋窝淋巴结 FNAB 样本，其中 187 例（52.8%）为乳腺来源转移性癌阳性；143 例（40.4%）为阴性；12 例（3.4%）显示为非典型细胞；6 例（1.7%）为可疑转移；6 例（1.7%）因缺乏淋巴组织和恶性细胞而无法诊断。在 143 例 FNAB 阴性样本中，22 例（15.4%）在术中 SLNB 或 ALND 中呈阳性。当仅考虑 FNAB 阳性和阴性样本时（n=330；93.2%），总体诊断敏感性和特异性分别为 89.4%和 99.2%。
虽然腋窝 SLNB 是检测乳腺来源淋巴结转移的标准程序，但在很大一部分患者中，腋窝淋巴结 FNAB 似乎是一种合适的替代方法。对于 FNAB 阴性腋窝淋巴结的病例，特别是存在异常影像学表现的淋巴结，应进行标准的 SLNB。
