Results of sentinel lymph node diagnostics in patients with cT1–2N0–1 breast cancer using intraoperative three-vector fine-needle aspiration biopsy

Background. The article advances a hypothesis that sentinel lymph node lesions can be detected using intraoperative three-vector fine-needle aspiration biopsy which does not require lymph node dissection. After identification of the sentinel lymph node using standard techniques, material was extracted through three-vector aspiration with immediate cytology, subsequent resection of the lymph node with immediate cytology of touch smears, scrapings and further planned morphological examination. Aim. To evaluate the efficacy of the proposed approach in patients with primary operable forms of breast cancer (stages T1–2N0–1). Materials and methods. The prospective study included 70 women diagnosed with stage I–IIB ductal or lobular breast cancer. Mean age of the patients was 54.2 (34–78) years. In most cases the disease was detected at early stage: stage IА was diagnosed in 74.3 % of patients, IIА – in 25.7 %. Morphological examination confirmed invasive ductal carcinoma in 85.8 % of cases with it being the most common histological type. In terms of molecular subtype, the most common was luminal B HER2neu-negative breast cancer: 58.6 % of patients, and luminal А cancer: in 41.4 %. In 74.3 % of patients, breast cancer was moderately differentiated. Results. The use of intraoperative three-vector fine-needle aspiration biopsy with subsequent evaluation of cytology and planned histological analysis of the sentinel lymph node in patients with breast cancer allowed to determine diagnostic parameters of the developed technique. Sensitivity of the method was 81.2 % with 2 false negative cases, while specificity reached 100 %, and overall diagnostic accuracy 94.6 %. Prognostic significances of positive and negative results were 69.2 and 93.8 %, respectively. Sensitivity, specificity, prognostic significance of positive result of three-vector fine-needle aspiration biopsy were respectively 19.7; 0.7 and 12.1 % higher than the standard method of immediate cytology of touch smears. Conclusion. The developed method can be recommended for wide use in T1–2N0–1 breast cancer.

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