Indications for biopsy of imaging‐detected intramammary and axillary lymph nodes in the absence of concurrent breast cancer. Issue 6 (8th March 2018)

• Record Type: Journal Article
• Authors: Dialani, Vandana; Westra, Christine; Venkataraman, Shambhavi; Fein‐Zachary, Valerie; Brook, Alexander; Mehta, Tejas
• Is Part Of: Breast journal. Volume 24:Issue 6(2018)
• Page Start: 869
• Page End: 875
• Publication Date: 2018-03-08
• Subjects: axillary lymph node -- axillary ultrasound -- intramammary lymph node -- ultrasound; Breast -- Diseases -- Periodicals; Breast -- Cancer -- Periodicals; 618.19
• DOI: 10.1111/tbj.13009
• Languages: English
• ISSNs: 1075-122X

Abstract

Abstract: To evaluate the prevalence of malignancy in imaging‐detected abnormal lymph nodes (LNs) in women without concurrent cancer and to identify imaging features predictive of malignancy in this population. This is an IRB‐approved study with waived informed consent. We retrospectively reviewed medical records of all image‐guided LN FNAs and CNBs performed at our institution from 1/1/08 through 12/31/10. LNs sampled in patients without concurrent breast cancer comprised our study group (SG; n = 77), and with concurrent breast cancer our reference group (RG; n = 124). Blinded to cytology/histology, imaging features of the LNs including size, loss of fatty hilum, and cortical thickness were reviewed. A low/high suspicion category was then assigned based on LN appearance. The prevalence of malignancy in LNs in SG was 6% (5/77) and in RG 52% (64/124; P < .0001). Complete loss of fatty hilum had 100% (5/5) sensitivity, and 100% (56/56) NPV for detecting cancer in SG, compared to 39% (25/64) sensitivity and 61% (60/99) NPV in RG. When a "high suspicion" imaging feature was used as a threshold to biopsy, the sensitivity (5/5) and NPV (45/45) in SG were 100%, and in RG 78% (50/64) and 77% (47/61), respectively. The prevalence of cancer in imaging‐detected abnormal LNs in patients without concurrent breast cancer is low. In the absence of concurrent cancer, using highly suspicious features of loss of fatty hilum or cortical thickness ≥ 5 mm as a threshold to biopsy will maintain high sensitivity with lower false‐positive biopsy rate.