Fine-needle aspiration biopsy of axillary lymph nodes

Our plain-English summary of Fine-needle aspiration biopsy of axillary lymph nodes, by S. Jaffer, M. Zakowski (Diagnostic Cytopathology, 2002).

The study

• Authors: S. Jaffer, M. Zakowski
• Journal: Diagnostic Cytopathology
• Published: 2002;26(2):69-74
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

To assess the efficacy of fine-needle aspiration biopsy (FNAB) of axillary lymph nodes (ALN), we retrospectively analyzed 140 FNAB of ALN at Memorial Sloan-Kettering Cancer Center, examining technique and cytologic-histologic correlation. Of the 140 FNAB, 124 were performed by the conventional method and 16 by ultrasound guidance (USG). The diagnoses included: unsatisfactory, 20; negative, 38; positive, 72; suspicious, 6; and indeterminate, 4. Positive diagnoses included: carcinoma, 44.4%; melanoma, 43.0%; lymphoma, 5.6%; sarcoma, 5.6%; and mesothelioma, 1.4%; one of which was false-positive, attributed to misinterpretation. All indeterminate and most false-negative cases were due to lymphoproliferative conditions. The sensitivity and specificity of FNAB of ALN were 94.7% and 97.1% and the adequacy rate was 85.7%. The sensitivity, specificity, and adequacy rates of USG FNAB were 100%. Our study shows that FNAB of ALN is an excellent method for diagnosing reactive conditions as well as neoplasms.

In plain English

This was a retrospective study from Memorial Sloan-Kettering Cancer Center in New York. It looked at fine-needle aspiration biopsies of lymph nodes in the armpit (axillary lymph nodes). It did not study asbestos exposure. The authors reviewed 140 biopsies done from 1992 to 1998 in 130 patients. Of these, 124 were done by the conventional method and 16 with ultrasound guidance. Of the 140 biopsies, 72 were positive for malignancy, 38 negative, 20 unsatisfactory, 6 suspicious and 4 indeterminate. One of the 72 positive results (1.4%) was metastatic mesothelioma, diagnosed with help from comparison with the patient's primary pleural mesothelioma. Most other positives were carcinoma or melanoma. Overall sensitivity was 94.7%, specificity 97.1% and adequacy 85.7%. For the ultrasound-guided biopsies, all three were 100%. Lymphoproliferative conditions (such as lymphoma) accounted for 75% of the false-negative cases. The authors concluded that the method is rapid, cost-effective and highly accurate, and may be improved with ultrasound guidance. They noted that the ultrasound-guided group was small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of fine-needle aspiration biopsies, comparing the cytology results with later tissue biopsy (histology) or clinical follow-up
• Who was studied: 140 fine-needle aspiration biopsies of axillary lymph nodes in 130 patients (65 females, 65 males, aged 16 to 89) at Memorial Sloan-Kettering Cancer Center, New York, 1992 to 1998; 124 biopsies conventional, 16 ultrasound-guided
• Exposure: Not an exposure study: the article evaluated a diagnostic procedure and does not report asbestos or any other exposure
• Main results:
  • Of all 140 biopsies: 20 (14.3%) unsatisfactory, 38 (27.1%) negative, 72 (51.4%) positive, 6 (4.3%) suspicious, 4 (2.9%) significant atypia/indeterminate
  • Of the 72 positive biopsies: carcinoma 32 (44.4%), melanoma 31 (43.0%), lymphoma 4 (5.6%), sarcoma 4 (5.6%), mesothelioma 1 (1.4%)
  • The single mesothelioma case was metastatic mesothelioma, diagnosed with help from comparison with the patient's primary pleural mesothelioma
  • For all biopsies of axillary lymph nodes: sensitivity 94.7%, specificity 97.1%, adequacy rate 85.7%
  • Positive predictive value was 98.6% and negative predictive value was 75%
  • For the 16 ultrasound-guided biopsies: sensitivity, specificity and adequacy were all 100%
  • Of the 38 negative biopsies, 12 had a follow-up tissue biopsy; 8 of these agreed with the negative result and 4 showed malignancy
  • Lymphoproliferative conditions accounted for 75% of false-negative cases and 100% of indeterminate cases
• The authors' conclusion: The authors concluded that fine-needle aspiration biopsy of axillary lymph nodes is a rapid, cost-effective, highly accurate preliminary diagnostic method, especially for staging patients with previous malignancies such as breast carcinoma and melanoma. They said its accuracy may be further improved with ultrasound guidance, and that lymphoproliferative conditions were the most challenging cases.
• Limitations the authors state:
  • Only a small number of ultrasound-guided biopsies were studied; the authors said larger studies are needed to compare ultrasound-guided with conventional biopsy

Topics

Medical terms in this study, explained in our Lexicon: Fine-Needle Aspiration, Ultrasound, Carcinoma, Sarcoma, Mesothelioma, Neoplasm.

Related studies

• Diagnosis of malignant mesothelioma by fine needle aspiration of a cervical lymph node. A case report — N.A. Ansari, N.W. Derias (2000)
• Diagnosis of malignant pleural mesothelioma by axillary lymph node biopsy — S.B. Kim, B. Varkey, et al. (1987)
• Malignant pleural mesothelioma initially diagnosed on cervical lymph node biopsy — S. Ogata, S. Hiroi, et al. (2009)
• Clinical and pathological characteristic of metastatic malignant mesothelioma initially diagnosed by lymph node biopsy — X.L. Zhu, L.M. Gao, et al. (2017)
• Advantages of thoracic ultrasound-guided fine-needle aspiration biopsy in lung cancer and mesothelioma — M. Sperandeo, L. Dimitri, et al. (2014)
• Cytopathology of malignant mesothelioma of the pleura in fine-needle aspiration biopsy — G.K. Nguyen, M.R. Akin, et al. (1999)

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