Abstract
The purpose of this study was to assess the usefulness of HER2 levels in ultrasonographically guided fine-needle aspiration biopsy (US-FNA) aspirates of axillary lymph nodes (ALNs) in the determination of lymph node metastasis or the characterization of primary breast cancer, and to correlate the HER2 levels in US-FNA aspirates (FNA-HER2s) of metastatic ALNs with the HER2 statuses of corresponding primary breast cancers. An institutional review board approved the study. Between January and October 2010, 164 patients with 167 ALNs examined by US-FNA were included. FNA-HER2s of ALNs were measured by chemiluminescence immunoassay, and they were correlated with cytologic/final diagnoses. Receiver operating characteristics (ROC) curve analysis was performed to evaluate the diagnostic ability to differentiate benign and metastatic ALNs. Additionally, FNA-HER2s of metastatic ALNs were correlated with HER2 status and other clinicopathologic variables of the primary breast cancers. Among the 167 ALNs, 138 were metastatic and 29 were benign. The mean FNA-HER2 (6.3 ng/ml) of metastatic ALNs was higher than that of benign ALNs. All 29 benign ALNs showed no measurable value of FNA-HER2 (0.0 ng/ml). The area under the ROC curves of FNA-HER2 of ALNs was 0.679 for the diagnosis of ALN metastasis. The FNA-HER2 statuses of 108 metastatic ALNs (79.4%) were concordant with the HER2 statuses of the corresponding primary breast cancers. In a subgroup analysis of HER2-positive cancers with ALN metastasis, distant metastasis was significantly associated with FNA-HER2-negativity of metastatic ALNs (P = 0.04). Although FNA-HER2 of ALNs did not improve the diagnostic performance of FNA cytology in preoperative diagnosis of ALN metastasis of overall patients, FNA-HER2-positive metastatic ALNs were significantly associated with HER2-positivity of primary breast cancers. Additionally, FNA-HER2 analysis of ALN may help to develop more personalized treatment protocol for breast cancer patients by determining the concordance or discordance of HER2 status between primary cancers and metastatic ALNs.
Highlights
Preoperative evaluation of axillary lymph node (ALN) status is important to predict prognosis and to decide treatment plans for breast cancer patients [1,2,3]
Broad ranges for the sensitivities (21 to 86%) and negative predictive values (65 to 90%) of axillary US combined with US-guided fine needle aspiration biopsy (US-fine needle aspiration biopsy (FNA)) have been reported [3,4,5,6,7,10,11], which means that axillary US combined with US-FNA may lead to a substantial number of false-negative cases in certain circumstances
The purpose of this study was to assess the usefulness of human epidermal growth factor receptor 2 (HER2) level measurement of US-FNA specimens (FNA-HER2) from ALNs in the determination of lymph node metastasis or characterization of primary breast cancer, and to compare the HER2 status of metastatic ALNs based on FNA-HER2 with that of primary breast cancer tissue
Summary
Preoperative evaluation of axillary lymph node (ALN) status is important to predict prognosis and to decide treatment plans for breast cancer patients [1,2,3]. Axillary ultrasound (US) and adjunctive US-guided fine needle aspiration biopsy (US-FNA) for ultrasonographically suspicious ALNs are widely used for preoperative staging of ALN, because of their simplicity and high specificity, ranging up to 100% [3,4,5,6,7]. Non-surgical accurate methods that can preoperatively determine ALN status would be clinically beneficial to simplify the ALN staging process and to reduce unnecessary SLNB. Given this situation, several studies have focused on identifying tumor markers to determine ALN metastasis using fine needle aspirates of ALN. Carcinoembryonic antigen (CEA), breast cancer antigen 15-3 (CA 15-3), and cytokeratin fragment 21-1 (CYFRA21-1) have been proposed to be tumor markers which may be helpful for preoperative diagnosis of ALN metastasis in breast cancer patients [12,13]
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