Li Joshua J X, Ng Joanna K M, Hon Nikki K Y, See Ka Wun, Tsang Julia Y S, Tse Gary M
Department of Pathology, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Island, Hong Kong.
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, 1/F, Clinical Sciences Building, New Territories, Hong Kong.
Breast Cancer Res Treat. 2025 Jan;209(1):15-20. doi: 10.1007/s10549-024-07533-1. Epub 2024 Nov 17.
Fine-needle aspiration cytology is preferred for axillary lymph node metastasis with low costs and minimal risks. To improve diagnostic performance by incorporating clinical-radiological-pathological parameters, a large cohort pre-operative aspirates in were reviewed for parameters affecting adequacy rate and accuracy.
Axillary nodal aspirates from three institutions with histologic correlation were retrieved. Case notes were reviewed for parameters pertaining to the primary tumor, nodal status, histologic and cytologic diagnoses.
Totally 1361 specimens were included. The risk of malignancy for C1-C5 categories were 53.39%, 27.45%, 70.97%, 83.33% and 88.00%, increasing to 75.86%, 94.59% and 99.28% for C3/C4/C5 categories excluding cases with neoadjuvant therapy. Node size (p < 0.001) and histologic grade (p = 0.003) of primary tumor positively correlated with specimen adequacy. Presence of in situ component trended towards inadequacy (p = 0.069). Lymph node size remained a strong predictor of concordant cytologic diagnosis (p < 0.001). A higher percentage of involved node (p = 0.006) and HER2 overexpressed breast cancers (p = 0.027) increased concordance. Cases with ≥ 4 (up to ≥ 10) positive nodes were more likely to be concordant (p = 0.009- < 0.001), with improvements of 8.27%-12.37%. For size, cut-offs of ≥ 5 and ≥ 10 mm were significant (p = 0.006- < 0.001).
It is critical that clinical-radiological-pathological findings be interpreted together with cytology. Aspirates from smaller nodes are more likely to be non-informative, irrespective of the total number of suspicious nodes, or a high-grade primary. In axillae with less than 4 suspicious nodes and/or a target node of less than 5-10 mm, the diagnostic accuracy of aspiration cytology decreases and should be interpreted cautiously.
细针穿刺细胞学检查因成本低、风险小，是腋窝淋巴结转移的首选检查方法。为通过整合临床-放射-病理参数提高诊断性能，我们回顾了大量术前穿刺样本，以分析影响取材成功率和准确性的参数。
收集来自三个机构且有组织学对照的腋窝淋巴结穿刺样本。查阅病例记录，获取与原发肿瘤、淋巴结状态、组织学和细胞学诊断相关的参数。
共纳入1361份样本。C1-C5类别的恶性风险分别为53.39%、27.45%、70.97%、83.33%和88.00%，排除新辅助治疗病例后，C3/C4/C5类别的恶性风险增至75.86%、94.59%和99.28%。原发肿瘤的淋巴结大小（p < 0.001）和组织学分级（p = 0.003）与样本取材成功率呈正相关。原位成分的存在有导致取材不足的趋势（p = 0.069）。淋巴结大小仍是细胞学诊断一致性的有力预测指标（p < 0.001）。受累淋巴结比例较高（p = 0.006）和HER2过表达的乳腺癌（p = 0.027），诊断一致性增加。有≥4个（最多≥10个）阳性淋巴结的病例更可能诊断一致（p = 0.009 - < 0.001），诊断一致性提高8.27% - 12.37%。对于淋巴结大小，≥5 mm和≥10 mm的临界值具有显著意义（p = 0.006 - < 0.001）。
临床-放射-病理检查结果与细胞学检查结果综合解读至关重要。无论可疑淋巴结总数或原发肿瘤分级如何，较小淋巴结的穿刺样本更可能无诊断价值。在腋窝有少于4个可疑淋巴结和/或目标淋巴结小于5 - 10 mm的情况下，穿刺细胞学检查的诊断准确性降低，应谨慎解读。
