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Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?

OBJECTIVE: To determine the diagnostic accuracy of ultrasound guided fine needle aspiration (FNA) cytology and core needle biopsy (CNB) of axillary lymph nodes pre-operatively in newly diagnosed operable primary breast cancer. METHODS: An observational study for all patients who underwent pre-operat...

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Autores principales: Vidya, Raghavan, Iqbal, Fahad Mujtaba, Bickley, Bernadette
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cancer Intelligence 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5365337/
https://www.ncbi.nlm.nih.gov/pubmed/28386294
http://dx.doi.org/10.3332/ecancer.2017.724
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author Vidya, Raghavan
Iqbal, Fahad Mujtaba
Bickley, Bernadette
author_facet Vidya, Raghavan
Iqbal, Fahad Mujtaba
Bickley, Bernadette
author_sort Vidya, Raghavan
collection PubMed
description OBJECTIVE: To determine the diagnostic accuracy of ultrasound guided fine needle aspiration (FNA) cytology and core needle biopsy (CNB) of axillary lymph nodes pre-operatively in newly diagnosed operable primary breast cancer. METHODS: An observational study for all patients who underwent pre-operative FNA cytology or CNB during September 2013–August 2014 was conducted at our institution (County Hospital, Stafford, UK). The accuracy of pre-operative axillary staging was compared to the post-operative histology. For this sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated. RESULTS: A total of 81 consecutive patients were evaluated by axillary ultrasound. Patients identified with potentially abnormal axillary lymph nodes underwent definitive surgery. Seven patients had positive cytology/histology who did not undergo definitive surgery and were excluded (N = 74) from the study. CNB had a sensitivity of 100% versus 72% (p = 0.006) for FNA cytology. Both had 100% specificity and PPV. The NPV of CNB was 100% versus 72% for FNA cytology. Among 35% of patients that underwent FNA cytology required repeat procedure versus 2.6% of patients who underwent CNB. 0/38 patients that had CNB required a second operation while 7/43 patients with negative FNA cytology had positive lymph nodes identified at sentinel lymph node biopsy (SLNB) requiring surgical re-intervention with axillary node clearance. CONCLUSION: CNB was superior to FNA cytology when interrogating the axilla. We recommend CNB to be adopted routinely in pre-operative axillary staging to reduce surgical re-intervention.
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spelling pubmed-53653372017-04-06 Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology? Vidya, Raghavan Iqbal, Fahad Mujtaba Bickley, Bernadette Ecancermedicalscience Clinical Study OBJECTIVE: To determine the diagnostic accuracy of ultrasound guided fine needle aspiration (FNA) cytology and core needle biopsy (CNB) of axillary lymph nodes pre-operatively in newly diagnosed operable primary breast cancer. METHODS: An observational study for all patients who underwent pre-operative FNA cytology or CNB during September 2013–August 2014 was conducted at our institution (County Hospital, Stafford, UK). The accuracy of pre-operative axillary staging was compared to the post-operative histology. For this sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated. RESULTS: A total of 81 consecutive patients were evaluated by axillary ultrasound. Patients identified with potentially abnormal axillary lymph nodes underwent definitive surgery. Seven patients had positive cytology/histology who did not undergo definitive surgery and were excluded (N = 74) from the study. CNB had a sensitivity of 100% versus 72% (p = 0.006) for FNA cytology. Both had 100% specificity and PPV. The NPV of CNB was 100% versus 72% for FNA cytology. Among 35% of patients that underwent FNA cytology required repeat procedure versus 2.6% of patients who underwent CNB. 0/38 patients that had CNB required a second operation while 7/43 patients with negative FNA cytology had positive lymph nodes identified at sentinel lymph node biopsy (SLNB) requiring surgical re-intervention with axillary node clearance. CONCLUSION: CNB was superior to FNA cytology when interrogating the axilla. We recommend CNB to be adopted routinely in pre-operative axillary staging to reduce surgical re-intervention. Cancer Intelligence 2017-03-07 /pmc/articles/PMC5365337/ /pubmed/28386294 http://dx.doi.org/10.3332/ecancer.2017.724 Text en © the authors; licensee ecancermedicalscience. http://creativecommons.org/licenses/by/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Vidya, Raghavan
Iqbal, Fahad Mujtaba
Bickley, Bernadette
Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?
title Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?
title_full Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?
title_fullStr Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?
title_full_unstemmed Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?
title_short Pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?
title_sort pre-operative axillary staging: should core biopsy be preferred to fine needle aspiration cytology?
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5365337/
https://www.ncbi.nlm.nih.gov/pubmed/28386294
http://dx.doi.org/10.3332/ecancer.2017.724
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