The Z0011 trial indicated that the information achieved by axillary dissecting lymph nodes (Ax LNs) does not change the prognosis of the disease for patients with clinical node negative breast cancer. Several clinical trials conduct the need for SNB in cases with negative ultrasound-guided (US) fine needle aspiration cytology (FNA) of the suspicious LNs. The aim of this study was to evaluate the reliability of CNB to detect positive LN compared to that of FNA.
A total of 1465 consecutive patients (pts) with breast cancer were prospectively identified at our institution between March, 2012 and April, 2016. The inclusion criteria of both FNA(21G) and CNB(16G) was cortical thickness greater than 3 mm or abnormal morphologic characteristics. Patients with biopsy-proved metastasis underwent Ax, and those with a negative FNA or CNB underwent SNB. If the SNB was positive, Ax was performed. Diagnostic accuracy was calculated for FNA and CNB.
The number of negative US of LNs was 744 pts, 440 FNA and 212 CNB were performed for suspicious LNs. Sensitivity, specificity, PPV, NPV, and accuracy were 83%, 99%, 97%, 88%, and 91% in FNA, and 93%, 99%, 99%, 97% and 97% in CNB, respectively. SNB was performed in 141 of 212 CNB and 254 of 463 FNA. 141CNB (T1;83,T2;52,T3;9 pts) treated with SNB were compared to 254 FNA (T1;127, T2;116,T3;11 pts) regarding the number of LNs metastasis. The number of positive SLNs and positive LNs more than 3 was 5 (4%), 0(0%) in CNB, and 35(14%), 15(6%) in FNA, respectively.
CNB is a reliable method for the preoperative diagnosis of LNs metastasis. If CNB shows negative LNs, SNB might be safely omitted for patients with breast cancer.
Clinical trial identification
Legal entity responsible for the study
Chiba Cancer Center
All authors have declared no conflicts of interest.