Feasibility of fine-needle aspiration for assessing responses to chemotherapy in metastatic nodes marked with clips in breast cancer: A prospective registry study

Abigail S. Caudle, Henry M. Kuerer, Savitri Krishnamurthy, Kyungmin Shin, Brian P. Hobbs, Junsheng Ma, Elizabeth A. Mittendorf, Ashley C. Washington, Sarah M. DeSnyder, Dalliah M. Black, Kelly K. Hunt, Wei T. Yang

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Background: Clips are often placed to mark axillary nodes with biopsy-confirmed metastases in patients with breast cancer. The evaluation of clipped nodes after chemotherapy can identify patients who have eradication of nodal disease. The goal of this study was to determine whether preoperative fine-needle aspiration (FNA) of clipped nodes after neoadjuvant chemotherapy (NAC) could predict the presence of residual disease. Methods: This prospective registry study enrolled 50 patients with a clip placed to mark nodes with biopsy-confirmed metastases who had completed NAC. Participants underwent FNA of the clipped node before seed-localized lymph node excision. FNA pathology was compared with surgical pathology. Results: There were 36 patients (72%) with residual disease on surgical pathology: 3 (8%) had a nondiagnostic aspirate, carcinoma was seen in 14 (39%), and 19 (53%) had a false-negative result. The sensitivity of FNA was 42.4%, its specificity was 100%, and its negative predictive value was 40.6%. In a univariate analysis, the odds of a true-positive result increased significantly with the mean initial size of the clipped node (odds ratio [OR], 4.3; P =.004) and the size of the metastatic focus after NAC (OR, 1.3; P = 0.003), whereas normalization of nodes after chemotherapy (OR, 0.1) and a lack of response on ultrasound (OR, 0.11) were associated with a false-negative result (P =.01). Conclusions: FNA of marked nodes after chemotherapy has a high false-negative rate. This highlights the need for surgical staging of the axilla after NAC to assess the response.

Original languageEnglish (US)
Pages (from-to)365-373
Number of pages9
JournalCancer
Volume125
Issue number3
DOIs
StatePublished - Feb 1 2019

Keywords

  • breast neoplasms
  • chemotherapy
  • fine-needle biopsy
  • lymph nodes
  • surgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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