Yield of flow cytometry in addition to cytology for lymph node sampling in patients with incidental axillary adenopathy without a concurrent diagnosis of primary breast malignancy Journal Article

   

Authors:	Lo Gullo, R.; Cloutier Lambert, C.; Lin, O.; Jochelson, M. S.; D'Alessio, D.
Article Title:	Yield of flow cytometry in addition to cytology for lymph node sampling in patients with incidental axillary adenopathy without a concurrent diagnosis of primary breast malignancy
Abstract:	Purpose: Non-specific lymphadenopathy is increasingly being reported especially given the COVID-19 vaccination campaign and is a diagnostic dilemma especially in oncology patients. The purpose of this study was to evaluate the diagnostic accuracy and discordance rate between fine-needle aspiration (FNA) cytology and flow cytometry (FC) immunophenotyping in axillary FNA in patients with morphologically abnormal axillary lymph nodes on imaging and no concurrent diagnosis of primary breast malignancy. Methods: This retrospective study included 222 patients who underwent screening or diagnostic axillary ultrasound that yielded suspicious lymphadenopathy without concurrent or recent prior diagnosis of breast cancer and who had subsequent image-guided axillary FNA and FC. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value (PPV and NPV) were reported for FNA with cytology alone, and FC alone, and in combination. Discordance rate between FNA cytology and FC was assessed. Discordant cases were evaluated with histology or clinical and imaging follow-up. Results: Diagnostic sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 88%, 92%, 77%, 96%, and 91%, for FNA alone, 98%, 98%, 92%, 99%, and 98% for FC alone, and 100%, 92%, 79%, 100%, and 94% when combined. The overall discordance rate between FNA and FC was 7% (16/222). 7/16 (44%) patients with discordant results were diagnosed with lymphoma, while 9/16 (56%) patients with discordant results had benign findings. Conclusion: With a diagnostic accuracy of 91%, FNA with cytology is sufficient to screen patients with indeterminate and incidental lymphadenopathy. Flow cytometry could be initially deferred in patients with low pretest probability of lymphoma. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Keywords:	retrospective studies; flow cytometry; lymph node metastasis; lymph nodes; lymphatic metastasis; sensitivity and specificity; cytology; breast neoplasms; retrospective study; breast tumor; lymph node; lymphoma; lymphadenopathy; fine-needle aspiration; humans; human; female; covid-19; sars-cov-2; covid-19 vaccines; non-specific lymphadenopathy
Journal Title:	Breast Cancer Research and Treatment
Volume:	191
Issue:	3
ISSN:	0167-6806
Publisher:	Springer
Date Published:	2022-02-01
Start Page:	677
End Page:	683
Language:	English
DOI:	10.1007/s10549-021-06473-4
PUBMED:	35013915
PROVIDER:	scopus
PMCID:	PMC8747879
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85122912132&doi=10.1007%2fs10549-021-06473-4&partnerID=40&md5=22d4cbdeafea1b30db95c1bde4129914
Notes:	Article -- Export Date: 1 March 2022 -- Source: Scopus

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