False Negative Results in Axillary Lymph Nodes by Ultrasonography and Ultrasonography-Guided Fine-Needle Aspiration in Patients with Invasive Ductal Carcinoma

Abstract

Purpose: For preoperative evaluation of ALN status using various methods, axillary US and subsequent US-FNA targeting the LNs suspicious for metastasis are the most widely used methods. The purpose of our study was to assess the rate of false-negative results at preoperative ultrasonography (US) and ultrasonography guided fine needle aspiration (US-FNA) of axillary lymph nodes (ALNs) in breast cancer patients and the number of false-negative lymph nodes, and to evaluate factors related to ALN false negative results in US and/or US-FNA in patients diagnosed with invasive ductal carcinoma.

Materials and Methods: Among 317 patients who underwent surgery for invasive ductal carcinoma during 2009 in Severance hospital, 237 patients had no reported ALN metastasis on preoperative US-FNA and US. We retrospectively reviewed the subsequent surgical pathology and clinicopathologic findings and assessed the rate of false-negative results from US and US-FNA of ALN and the number of false-negative lymph node. We performed univariate analysis and multivariate logistic regression analysis to evaluate the relationships between variable clinicopathologic factors (T-stage, position of ALN, hormone receptors, histologic grade, lymphovascular invasion (LVI) and performance of FNA) and cytologic results (false-negative result; FNALN and true negative result; TNALN) from US and/or US-FNA of ALN.

Results: The rate of false-negative results was 42.4 % (59/139) in both US and US-FNA of ALN but among them, 57.6 % (34/59) showed only one metastatic ALN. Breast cancer with FNALN on US and US-FNA was significantly related to positive estrogen receptor (p = 0.003), positive progesterone receptor (p = 0.001), and the presence of LVI (p = 0.004) in univariate analysis. In multivariate analysis, high T stages (≥ T2, odds ratio (OR) 4.007, p = 0.004) and LVI (OR 7.951, p = 0.001) showed significant correlation with FNALN on US and US-FNA.

Conclusion: More than half of patients with FNALN showed only one metastatic ALN. LVI and high T-stages were the most important factors attributed to FNALN on US and US-FNA in patients with invasive ductal carcinoma.

Zusammenfassung

Ziel: Für die präoperative Bewertung des axillären Lymphknoten(ALK-)Status mit verschiedenen Methoden sind die axilläre Sonografie und die darauf folgende Fokussierung der für Metastasen verdächtigen Lymphknoten mittels ultraschallgestützter Feinnadelpunktion (US-FNP) die am häufigsten eingesetzten Methoden. Das Ziel unserer Studie war es, die Rate an falsch negativen Ergebnissen beim präoperativen Ultraschall (US) und bei der ultraschallgestützten Feinnadelpunktion der axillären Lymphknoten bei Patienten mit Mammakarzinom zu berechnen und die Anzahl der falsch negativen Lymphknoten und der Faktoren zu bewerten, die mit den ALK falsch negativen Ergebnissen im US und/oder der US-FNP bei Patienten mit invasiv-duktalem Karzinom in Verbindung stehen.

Material und Methoden: Von den 317 Patientinnen, bei denen im Jahre 2009 im Severance Hospital aufgrund eines invasiv-duktalen Karzinoms eine Operation vorgenommen wurde, hatten 237 Patienten aufgrund der präoperativen US-FNP und des US keine ALK-Metastasen. Wir überprüften retrospektiv die darauffolgende chirurgische Pathologie und die klinisch-pathologischen Befunde und bestimmten die Rate der falsch negativen ALK-Ergebnisse in US und US-FNP und die Anzahl der falsch negativen Lymphknoten. Wir führten eine univariante Analyse und multivariante logistische Regressionsanalyse durch, um die Verhältnisse zwischen den verschiedenen klinisch-pathologischen Faktoren (T-Stadium, Lage der ALK, Hormonrezeptoren, histologische Graduierung, lymphovaskuläre Invasion [LVI] und Durchführung der FNP) und zytologischen Befunden (falsch negatives Ergebnis; FNALK und echt negatives Ergebnis; TNALK) in Bezug US und/oder US-FNP des ALK zu bewerten.

Ergebnisse: Die Rate an falsch negativen Ergebnissen betrug 42,4 % (59/139) sowohl im US als auch der US-FNP der ALK, aber davon zeigten 57,6 % (34/59) nur eine ALK-Metastase. Mammakarzinome mit FNALK im US und der US-FNP zeigten in der univarianten Analyse eine signifikante Korrelation zum positiven Östrogen-Rezeptor (p = 0,003), positiven Progesteron-Rezeptor (p = 0,001), und dem Vorliegen einer LVI (p = 0,004). Bei der multivarianten Analyse zeigten hohe T-Stadien (≥ T2, Odds Ratio [OR] 4,007, p = 0,004) und eine LVI (OR 7,951, p = 0,001) eine signifikante Korrelation zu FNALK im US und der US-FNP.

Schlussfolgerung: Mehr als die Hälfte der Patienten mit FNALK wiesen nur eine ALK-Metastase auf. LVI und hohe T-Stadien waren die wichtigsten Faktoren im Zusammenhang mit FNALK im US und der US-FNP bei Patienten mit invasiv-duktalem Karzinom.

Key words

breast - ultrasound - biopsy - lymphatic

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