Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;11(5):2151-2161.
doi: 10.21037/qims-20-1030.

Specimen number based diagnostic yields of suspicious axillary lymph nodes in core biopsy in breast cancer: clinical implications from a prospective exploratory study

Yue Hu  1   2 , Jingsi Mei  1   2 , Yaping Yang  1   2 , Ran Gu  1   2 , Jiajie Zhong  3 , Xiaofang Jiang  1   2 , Fengtao Liu  1   2 , Juanjuan Yong  3 , Hongli Wang  1   2 , Shiyu Shen  1   2 , Jing Liang  1   2 , Qiang Liu  1   2 , Chang Gong  1   2   4
Affiliations

Specimen number based diagnostic yields of suspicious axillary lymph nodes in core biopsy in breast cancer: clinical implications from a prospective exploratory study

Yue Hu et al. Quant Imaging Med Surg. 2021 May.

Abstract

Background: Ultrasound (US)-guided core needle biopsy (CNB) is widely applied in the pathological diagnosis of suspicious axillary lymph nodes (ALNs) in breast cancer. However, the number of specimens removed during biopsy is currently based on the preference of the individual radiologist. This study aims to analyze the specimen number based diagnostic yields of US guided CNB of suspicious ALNs in breast cancer.

Methods: Core biopsy specimens of suspicious lymph nodes were prospectively obtained from breast cancer patients treated at our hospital between November, 2018, and July, 2019. Four specimens were obtained from each patient and labeled 1-4 in the order they were removed. Each specimen underwent pathological evaluation to determine whether metastasis had occurred. The diagnostic yields of the specimens were calculated and differences in diagnostic accuracy according to the number of specimens were evaluated by McNemar's test.

Results: A total of 167 patients were enrolled, and 139 (83.2%) cases were identified as metastasis by CNB. The diagnostic yields were: 74.2% (specimen 1), 87.8% (specimens 1-2), 91.2% (specimens 1-3), and 94.6% (specimens 1-4). The increases in diagnostic yield from specimen 1 to 1-2 and from specimens 1-2 to 1-4 were significant; however, no significant differences were detected between specimens 1-3 and the first two, or between specimens 1-4 and the first three in this sample size. The lower diagnostic abilities for the first two specimens were associated with shorter long- and short-axis lengths of lymph nodes on US.

Conclusions: Although the second specimen contributed significant diagnostic yield of suspicious axillary lymph nodes in core biopsy in breast cancer, a minimum number cannot be determined by this study. Additional specimens may improve diagnostic yield particularly in patients with small nodes.

Keywords: Breast cancer; axillary lymph node (ALN); core needle biopsy (CNB); specimen; ultrasound (US).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-1030). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Algorithm for axillary staging. US, ultrasound; SLNB, sentinel lymph node biopsy; ALND, axillary lymph node dissection.
Figure 2
Figure 2
Flowchart of patients. ALN, axillary lymph node; US, ultrasound; CNB, core needle biopsy; NAC, neoadjuvant chemotherapy.
Figure 3
Figure 3
Invasive ductal carcinoma in a 73-year-old woman with a negative result of axillary lymph node CNB but two lymph nodes metastases after surgery. (A) Gray-scale US image of the ipsilateral axilla shows a small (0.7×0.5 cm) suspicious lymph node with an absent fatty hilum. (B) US image obtained post-firing of CNB shows that the needle passes the lymph node precisely, but the visualization of needle may be caused by the artifact from partial volume effects. CNB, core needle biopsy; US, ultrasound.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Humphrey KL, Saksena MA, Freer PE, Smith BL, Rafferty EA. To do or not to do: axillary nodal evaluation after ACOSOGZ0011 Trial. Radiographics 2014;34:1807-16. 10.1148/rg.347130141 - DOI - PubMed
    1. Boughey JC, Moriarty JP, Degnim AC, Gregg MS, Egginton JS, Long KH. Cost modeling of preoperative axillary ultrasound and fine-needle aspiration to guide surgery for invasive breast cancer. Ann Surg Oncol 2010;17:953-8. 10.1245/s10434-010-0919-1 - DOI - PMC - PubMed
    1. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Robertson C, Maisonneuve P, Renne G, De Cicco C, De Lucia F, Gennari R. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349:546-53. 10.1056/NEJMoa012782 - DOI - PubMed
    1. Lyman GH, Giuliano AE, Somerfield MR, Benson AB, III, Bodurka DC, Burstein HJ, Cochran AJ, Cody HS, III, Edge SB, Galper S. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005;23:7703-20. 10.1200/JCO.2005.08.001 - DOI - PubMed
    1. National comprehensive cancer network. NCCN guidelines. Available online: https://www.nccn.org/professionals/physician_gls/default.aspx

LinkOut - more resources