Ultrasound guided needle biopsy of axilla to evaluate nodal metastasis after preoperative systemic therapy in cohort of 106 breast cancers enriched with BRCA1/2 pathogenic variant carriers.

IF 2 4区医学 Q3 ONCOLOGY Hereditary Cancer in Clinical Practice Pub Date : 2021-07-07 DOI:10.1186/s13053-021-00187-w

Baiba Līcīte, Arvīds Irmejs, Jeļena Maksimenko, Pēteris Loža, Genādijs Trofimovičs, Edvīns Miklaševičs, Jurijs Nazarovs, Māra Romanovska, Justīne Deičmane, Reinis Irmejs, Gunta Purkalne, Jānis Gardovskis

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Abstract

Background: 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).

Methods: From 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.

Results: False 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 %.

Conclusion: FNAC 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.

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在 BRCA1/2 致病变异携带者所组成的 106 例乳腺癌患者中，通过超声引导下的腋窝针刺活检评估术前系统治疗后的结节转移情况。

研究背景本研究旨在评估超声引导下细针穿刺细胞学检查（FNAC）在术前系统治疗（PST）后对结节阳性乳腺癌重新分期中的作用：研究纳入了2016年1月至2020年10月期间接受PST治疗的106例结节阳性IIA-IIIC期乳腺癌病例。18例（17%）为BRCA1/2致病变异携带者。PST 后，对腋窝进行了重新分期，并对明显和/或最可疑的腋窝结节进行了超声和 FNAC 检查。72/106例患者进行了保腋窝手术，34/106例患者进行了腋窝淋巴结清扫术（ALND）：结果：在整个组别和 BRCA1/2 阳性亚组中，PST 后 FNAC 的假阳性率（FPR）分别为 8%和 0%，假阴性率（FNR）分别为 43%和 18%。总体敏感性为 55%，特异性为 93%，准确性为 70%：PST后的FNAC假阴性率较低，有助于预测腋窝残留疾病，并简化BRCA1/2阳性和阴性亚组的ALND手术决策。总体队列中的 FNR 较高，单靠 FNAC 无法预测 ypCR 和省略进一步的腋窝手术。不过，FNAC 在 BRCA1/2 阳性亚组中的表现更有希望，有必要对更多病例进行进一步研究，以确认结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hereditary Cancer in Clinical Practice 医学-肿瘤学

CiteScore

3.10

自引率

5.90%

发文量

审稿时长

>12 weeks

期刊介绍： Hereditary Cancer in Clinical Practice is an open access journal that publishes articles of interest for the cancer genetics community and serves as a discussion forum for the development appropriate healthcare strategies. Cancer genetics encompasses a wide variety of disciplines and knowledge in the field is rapidly growing, especially as the amount of information linking genetic differences to inherited cancer predispositions continues expanding. With the increased knowledge of genetic variability and how this relates to cancer risk there is a growing demand not only to disseminate this information into clinical practice but also to enable competent debate concerning how such information is managed and what it implies for patient care. Topics covered by the journal include but are not limited to: Original research articles on any aspect of inherited predispositions to cancer. Reviews of inherited cancer predispositions. Application of molecular and cytogenetic analysis to clinical decision making. Clinical aspects of the management of hereditary cancers. Genetic counselling issues associated with cancer genetics. The role of registries in improving health care of patients with an inherited predisposition to cancer.