Abstract
BackgroundAim of the study is to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after preoperative systemic therapy (PST).MethodsFrom January 2016 – October 2020 106 node positive stage IIA-IIIC breast cancer cases undergoing PST were included in the study. 18 (17 %) were carriers of pathogenic variant in BRCA1/2. After PST restaging of axilla was performed with ultrasound and FNAC of the marked and/or the most suspicious axillary node. In 72/106 cases axilla conserving surgery and in 34/106 cases axillary lymph node dissection (ALND) was performed.ResultsFalse Positive Rate (FPR) of FNAC after PST in whole cohort and BRCA1/2 positive subgroup is 8 and 0 % and False Negative Rate (FNR) – 43 and 18 % respectively. Overall Sensitivity − 55 %, specificity- 93 %, accuracy 70 %.ConclusionFNAC after PST has low FPR and is useful to predict residual axillary disease and to streamline surgical decision making regarding ALND both in BRCA1/2 positive and negative subgroups. FNR is high in overall cohort and FNAC alone are not able to predict ypCR and omission of further axillary surgery. However, FNAC performance in BRCA1/2 positive subgroup is more promising and further research with larger number of cases is necessary to confirm the results.
Highlights
Aim of the study is to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after preoperative systemic therapy (PST)
From January 2016 – October 2020 106 FNAC confirmed node positive stage IIA-IIIC breast cancer cases undergoing PST were recruited to the study, including 18 (17 %) carriers of pathogenic variant in BRCA1 (2300T > G, 5- 4154delA, 7-5382insC, 2- c.5117G > A, 1del exon20) and BRCA2 (1- 9097delA)
In final surgical pathology in 65/106 (61 %) cases malignant cells persisted in axillary lymph nodes, but in 41/106 (39 %) cases no nodal tumor was detected after PST
Summary
Aim of the study is to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after preoperative systemic therapy (PST). According to recent studies pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in node positive breast cancer is observed in up to 40–75 % of cases [1,2,3,4]. BRCA1 positive breast cancer subgroup has high rate of pCR – up to 61 % [5]. It means that preoperative systemic therapy has completely eliminated all regional cancer involvement and total removal of all axillary lymph nodes is not justified. Several preoperative and intraoperative axillary reevaluation approaches have been studied recently including physical examination, imaging (e.g. ultrasound, PET-CT) and biopsy techniques [8, 9]. Combined clipped and sentinel node biopsy approach has very low false negative rate 1,4 %, but disadvantage is necessity of intraoperative frozen section and/or potential for repeated axillary surgery in cN2 and cN3 cases [9]
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