Core needle biopsy is an inferior tool for diagnosing cervical lymphoma compared to lymph node excision

Abstract Background Sentinel lymph node biopsy (SLNB) is unnecessarily performed too often, owing to the high upstaging rates of ductal carcinoma in situ (DCIS). This study aimed to evaluate the upstaging rates of DCIS to invasive cancer, determine the prevalence of axillary lymph node metastasis, and identify the clinicopathological factors associated with upstaging and lymph node metastasis. We also examined surgical patterns among DCIS patients and determined whether SLNB guidelines were followed. Methods We retrospectively analysed 307 consecutive DCIS patients diagnosed by preoperative biopsy in a single centre between 2014 and 2018. Data from clinical records, including imaging studies, axillary and breast surgery types, and pathology results from preoperative and postoperative biopsies, were extracted. Univariate analyses using Chi-square tests and multiple logistic regression analyses were used to analyse the data. Results The rate of upstaging to invasive cancer was 19.2% (59/307). DCIS diagnosed by core-needle biopsy (odds ratio [OR]: 6.861, 95% confidence interval [CI]: 2.429–19.379), the presence of ultrasonic mass-forming lesions (OR: 2.782, 95% CI: 1.224–6.320), and progesterone receptor-negative status (OR: 3.156, 95% CI: 1.197–8.323) were found to be associated with upstaging. The rate of sentinel lymph node metastasis was only 1.9% (4/202), and all were total mastectomy patients diagnosed by core-needle biopsy. SLNB was performed in 37.2% of 145 breast-conserving surgery patients and 91.4% of 162 total mastectomy patients. Among the 202 patients who underwent SLNB, 145 (71.7%) without invasive cancer on final pathology had redundant SLNB. Two of 59 patients (3.4%) with disease upstaged to invasive cancer had inadequate primary staging of the axilla, as the rate seemed sufficiently small. Conclusions In patients with a preoperative diagnosis of DCIS, although an unavoidable possibility of upstaging to invasive cancer exists, axillary metastasis is unlikely. Only 2.7% of patients with DCIS undergoing total mastectomy were found to have sentinel lymph node metastases. SLNB should not be performed in breast-conserving surgery patients and should be reserved only for total mastectomy patients diagnosed by core-needle biopsy.

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The Diagnostic Accuarcy Of Ultrasound-guided Core Needle Biopsy Of Axillary Lymph Node and related factors of false negativity In Breast Cancer Patient

European Journal of Cancer ◽

10.1016/s0959-8049(18)30705-6 ◽

2018 ◽

Vol 92 ◽

pp. S160

Author(s):

K. Chang Jong ◽

B.J. Chae ◽

H.J. Youn ◽

S.S. Jung

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patient ◽

Core Needle Biopsy ◽

Axillary Lymph Node ◽

Needle Biopsy ◽

Axillary Lymph ◽

Ultrasound Guided ◽

Related Factors ◽

Core Needle

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A Rapidly Enlarging Squamous Inclusion Cyst in an Axillary Lymph Node following Core Needle Biopsy

Case Reports in Pathology ◽

10.1155/2012/418070 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Cunxian Zhang ◽

Jinjun Xiong ◽

M. Ruhul Quddus ◽

Joyce J. Ou ◽

Katrine Hansen ◽

...

Keyword(s):

Lymph Node ◽

Core Needle Biopsy ◽

Axillary Lymph Node ◽

Needle Biopsy ◽

Axillary Lymph ◽

Inclusion Cyst ◽

Epithelioid Cells ◽

Core Needle ◽

Reactive Changes ◽

Touch Preparation

A 73-year-old woman was found to have a 1.7 cm axillary mass, for which a core needle biopsy was performed. The specimen revealed fragmented squamous epithelium surrounded by lymphoid tissue consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. Within one month, the lesion enlarged to 5 cm and was excised. Touch preparation cytology during intraoperative consultation displayed numerous single and sheets of atypical epithelioid cells with enlarged nuclei and occasional mitoses, suggesting a carcinoma. However, multinucleated giant cells and neutrophils in the background indicated reactive changes. We interpreted the touch preparation as atypical and recommended conservative surgical management. Permanent sections revealed a ruptured squamous inclusion cyst in a lymph node with extensive reactive changes. Retrospectively, the atypical epithelioid cells on touch preparation corresponded to reactive histiocytes. This is the first case report of a rapidly enlarging ruptured squamous inclusion cyst in an axillary lymph node following core needle biopsy. Our case demonstrates the diagnostic challenges related to a ruptured squamous inclusion cyst and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations.

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The Presence of Micropapillary Features and Retraction Artifact in Core Needle Biopsy Material Predicts Lymph Node Metastasis in Breast Carcinoma

The American Journal of Surgical Pathology ◽

10.1097/pas.0b013e318185e171 ◽

2009 ◽

Vol 33 (2) ◽

pp. 202-210 ◽

Cited By ~ 28

Author(s):

Geza Acs ◽

Gyorgy Paragh ◽

Shang-Tian Chuang ◽

Christine Laronga ◽

Paul J. Zhang

Keyword(s):

Lymph Node ◽

Breast Carcinoma ◽

Lymph Node Metastasis ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Biopsy Material ◽

Core Needle ◽

Node Metastasis

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Clinical Usefulness of Ultrasound-Guided Fine Needle Aspiration and Core Needle Biopsy for Patients with Axillary Lymphadenopathy

Medicina ◽

10.3390/medicina57070722 ◽

2021 ◽

Vol 57 (7) ◽

pp. 722

Author(s):

Tomoyuki Fujioka ◽

Mio Mori ◽

Kazunori Kubota ◽

Emi Yamaga ◽

Yuka Yashima ◽

...

Keyword(s):

Lymph Node ◽

Fine Needle Aspiration ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Diagnostic Performance ◽

Needle Aspiration ◽

Core Needle ◽

Fine Needle ◽

Axillary Lymphadenopathy ◽

Sensitivity Specificity

Background and Objectives: It is necessary to properly diagnose and manage axillary lymphadenopathy caused by a variety of diseases. This study aimed to evaluate the utility of ultrasound (US)-guided sampling in patients with axillary lymphadenopathy. Materials and Methods: Patients with axillary lymphadenopathy (excluding patients with newly diagnosed breast cancer) who underwent US-guided fine needle aspiration (FNA) or core needle biopsy (CNB) at a single center between February 2016 and September 2020 were retrospectively examined. The association between US imaging findings and malignancy was investigated and the diagnostic performance of US-guided sampling was assessed. Results: Fifty-five patients (including eight males) were included in the study; of these, 34 patients (61.8%) were finally diagnosed with a malignant lymph node lesion. Twenty-two patients (40.0%) had undergone FNA and 33 (60.0%) had undergone CNB. Larger short and long axis diameters, thicker lymph node cortex, and the absence of fatty hilum on the US were significantly associated with malignancy (p < 0.05). The diagnostic performance of FNA, CNB, and FNA + CNB was excellent (sensitivity, specificity, and accuracy of 0.909, 0.900, and 0.917 for FNA, 0.958, 1.000, and 0.970 for CNB, and 0.941, 0.952, and 0.945 for FNA + CNB, respectively). Conclusions: US-guided FNA and CNB play an important role in the diagnosis and management of patients with axillary lymphadenopathy

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Accuracy of Preoperative Ultrasound-Guided Axillary Lymph Node Core Needle Biopsy to Predict Axillary Lymph Node Involvement in Breast Cancer

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.06.12423 ◽

2021 ◽

Vol 104 (6) ◽

pp. 964-968

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Core Needle Biopsy ◽

Axillary Lymph Node ◽

Needle Biopsy ◽

Breast Cancer Surgery ◽

Axillary Lymph ◽

Ultrasound Guided ◽

Core Needle ◽

Preoperative Ultrasound

Background: Breast cancer operative management consists of breast surgery and axillary lymph node (ALN) assessment. ALN status is an important prognostic factor and determinant of breast cancer treatment. Objective: To investigate preoperative ultrasound-guided axillary lymph node core needle biopsy (USACNB) accuracy in predicting ALN involvement for breast cancer. Materials and Methods: This retrospective cohort study took place between February 2014 and May 2019. One hundred nine consecutive operable breast cancer patients with suspicious ALN involvement were assessed using preoperative USACNB and subsequent breast cancer surgery. Exclusion criteria were insufficient ALN tissue from USACNB for interpretation, previous breast or axillary surgery on the same side. Patients with preoperative histopathology results proving of metastasis underwent ALN dissection (ALND) while those with negative results had sentinel lymph node biopsy (SLNB). When SLNB was positive, ALND was then performed. Preoperative USACNB accuracy was analyzed using SLNB or ALND pathological results as standard tests. Results: The sensitivity, specificity, PPV, and NPV of preoperative USACNB in evaluating ALN involvement was 87.5%, 100%, 100%, and 80.4%, respectively, with an accuracy of 91.7%. Conclusion: Preoperative USACNB shows high diagnostic accuracy in ALN metastasis, but its NPV remains too low to completely rule out ALN involvement. Standard SLNB is still necessary in cases of negative USACNB. Keywords: Breast cancer; Ultrasound guided core needle biopsy; Axillary lymph node

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