International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
Bootstrap Slider

Indexed and Abstracted in: SCOPUS, Crossref, CAS Abstracts, Publons, CiteFactor, Open J-Gate, ROAD, Indian Citation Index (ICI), Indian Journals Index (IJINDEX), Internet Archive, IP Indexing, Google Scholar, Scientific Indexing Services, Index Copernicus, Science Central, Revistas Medicas Portuguesas, EBSCO, BOAI, SOROS, NEWJOUR, ResearchGATE, Ulrich's Periodicals Directory, DocStoc, PdfCast, getCITED, SkyDrive, Citebase, e-Print, WorldCat (World's largest network of library content and services), Electronic Journals Library by University Library of Regensburg, SciPeople.

Search Articles

Track manuscript

Readers around the world

Full Html

IJCRR - Vol 05 Issue 01, January, 2013

Pages: 54-57

Date of Publication: 30-Nov--0001


Print Article   Download XML  Download PDF

UTILITY OF ULTRASOUND GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN ASSESSING AXILLARY LYMPH NODE STATUS IN CARCINOMA BREAST

Author: Sandhyalakshmi B.N., Poornima Naregal , Rajeev Gothe, M.H. Kulkarni

Category: Healthcare

Abstract:Assessment of lymphnode status in carcinoma breast is an important factor in staging. Lymphnode status can be evaluated by different methods such as physical examination and sentinel node biopsy. Ultra sonography features such as round, hypo echoic, with loss of central hilum, eccentric cortical hypertrophy of lymphnode indicate the malignant involvement of lymph nodes. This study was conducted to evaluate the ultra sonography features of metastatically involved axillary lymphnodes. Ultrasound guided fine needle aspiration of involved axillary lymph nodes was done to confirm the findings. Ultrasonography of axillary lymphnodes will detect the small lymphnodes which can be missed on physical examination. Ultrasound guided fine needle aspiration will help in removal of metastatically involved lymphnodes in axillary clearance in a single surgery.

Keywords: Ultrasound, FNAC, Axillary lymphnode, Carcinoma breast.

Full Text:

INTRODUCTION
Axillary lymph node status is the most important prognostic factor in breast cancer. The presence of nodal metastases decreases 5-year survival by approximately 40% compared to node-negative patients. Noninvasive imaging techniques have been used to predict the preoperative axillary lymph node status. Ultra Sonography has higher diagnostic accuracy than mammography, computed tomography, magnetic resonance imaging, and positron emission tomography for diagnosing axillary node metastasis1,3.However axillary sonography has been shown to be moderately sensitive (48.8%–87.1%). UltraSonography is reported to be more sensitive in the detection of metastatic axillary lymph nodes than palpation or mammography2, 6 . Fine needle aspiration cytology (FNAC) of radiologically abnormal axillary lymph nodes in patients with breast cancer can identify patients suitable for primary axillary clearance rather than sentinel node biopsy, enabling surgical axillary staging by a single operation 4 .

MATERIALS AND METHODS This study was carried out in Karnataka institute of medical sciences, Hubli, Karnataka a tertiary care centre for one year (2006-2007). Thirty cases of carcinoma breast diagnosed on fine needle aspiration cytology were selected for detection of axillary lymphnode status. Axillary lymphnodes were palpated to know the presence in these 30 cases. Verbal consent was taken by the patients after explaining the procedure. They were subjected to conventional fine needle aspiration cytology first and US guided fine needle aspiration cytology later.

Philips HDI Ultrasonography machine along with hand held probe was used to determine the status of axillary lymphnodes. Ultrasonographically axillary nodes that are round, hypo echoic, with loss of central hilum, eccentric cortical hypertrophy were considered malignant and others were reactive. Lymphnodes either positive or negative on sonography basis were selected for fine needle aspiration cytology. Fine needle aspiration cytology was done using 5ml syringe with 20-22 gauge needle. Smears stained with H&E stain and Wright’s stain were examined. They were categorised as no material, reactive changes and metastatic deposits as depicted in Table 1 and Fig.1.

RESULTS In the present study, 2 cases did not have any axillary lymphnodes while on physical examination 6 were negative. Ultrasonography assesment of lymphnodes whether they were reactive or metastatically involved were complimented by FNAC. None of the cases on US guided FNAC showed no material while 8 cases yielded no material on conventional FNAC. Reactive features were seen in 10 cases on US guided FNAC and 3 cases on conventional FNAC. Metastatic deposits was seen in 18 cases on US guided FNAC and 13 on conventional FNAC. Physical examination did yield positive results only when the lymphnodes were of sufficient size (>2cms) but not for the lymphnodes which were smaller. Ultrasonography showed the lymphnodes immaterial of the size (smaller being 0.5cms) along with additional information of metastatic deposits as depicted in Table 2 and Figure 2.

DISCUSSION Breast cancer is the second most common malignancy in India after carcinoma of cervix 7 . The incidence of breast carcinoma is increasing among the young females. Early diagnosis of carcinoma will have better prognosis and has varied modalities of treatment. Initial assesment of a lump in a breast can be done with mammography, ultrasonography, fine needle aspiration cytology, core biopsy and excision biopsy. Once the lump has been diagnosed as carcinoma staging becomes the important prognostic factor. Assesment of axillary lymphnode status is an important factor in staging of breast cancer. Many of the times axillary lymphnodes are missed on physical examination of axilla owing to smaller size or deeper location and it will affect the staging. Traditional use of axillary sentinel node biopsy raised issue of false negative results 8 . These false negative cases may be because of massive metastasis in a single lymphnode in the draining area3 .The use of ultrasonography in detecting axillary lymphnode status has limited application because of low sensitivity (48.8%– 87.1%) 2 .

However use of sonography to detect metastically involved lymphnodes will reduce the sentinel lymphnode biopsies. It will also help in diagnosing metastatically involved lymphnodes which might have been missed on physical examination. Ultrasonography is much more cost effective , can be used in centres where the facility for CT and MRI are not available. US guided FNAC will compliment the diagnostic findings of sonography. With precise assesment of lymphnode status staging can be more accurate. Axillary clearence incase of involved nodes can be done with primary removal of breast tumor in a single operation. Hence it will reduce the two stage surgery or surgery at a later date.

CONCLUSION Ultra sonography of axillary lymphnodes will help in identifying the enlarged axillary lymphnodes which can be missed by physical examination. The charachteristic features of metastatically involved lymphnodes will help in proper staging of carcinoma breast. Ultra sonography guided fine needle aspiration cytology will compliment the findings and help in removal of metastatically involved lymphnodes in a single surgery.

ACKNOWLEDGEMENTS: To all the patients who were part of this study for their co-operation. To the editorial committee for accepting and publishing this artcle.

 

References:

1. Jae Jeong Choi, Bong Joo Kang, Sung Hun Kim, Ji Hye Lee, Seung Hee Jeong, Hyun Woo Yim et al. Role of Sonographic Elastography in the Differential Diagnosis of Axillary Lymph Nodes in Breast Cancer. J Ultrasound Med 2011; 30:429–436.

2. Isil Gunhan-Bilgen, Esin Emin Ustun, Aysenur Memis. Inflammatory Breast Carcinoma: Mammographic, Ultrasonographic, Clinical and Pathologic Findings in 142 cases. Radiology 2002; 223:829–838.

3. Soledad Alvarez, Enrique Añorbe, Pilar Alcorta, Fernando López, Ignacio Alonso, Julia Cortés. Role of Sonography in the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review. AJR 2006; 186:1342–1348.

4. Brian D Hayes, Linda Feeley, Cecily M Quinn, M M Kennedy, Ann O'Doherty, Fidelma Flanagan et al. Axillary fine needle aspiration cytology for pre-operative staging of patients with screen-detected invasive breast carcinoma. J Clin Pathol 2011;64: 338-342.

5. J N Bruneton, E Caramella, M Héry, D Aubanel, J J Manzino and J L Picard. Axillary lymph node metastases in breast cancer: preoperative detection with US. Radiology, 158, February 1986; 325- 326.

6. Valerie P.Jackson. The role of US in breast imaging. Radiology1990; 177:305-311.

7. Patra AK, Malik RN, Dash S. Fine needle aspiration as a primary diagnostic procedure of breast lumps. Indian J Pathol Microbiol 1991; 34(4):259-64.

8. Fraile M, Rull M, Julian FJ, et al. Sentinel node biopsy as a practical alternative to axillary lymphnode dissection in breast cancer patients: an approach to its validity. Ann Oncol 2000; 11:701–705.

Research Incentive Schemes

Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
Egg a day tied to lower risk of heart disease
88 Percent Of Delhi Population Has Vitamin D Deficiency: ASSOCHAM Report

List of Awardees

No Conference and Seminar

RSS feed

Indexed and Abstracted in


Antiplagiarism Policy: IJCRR strongly condemn and discourage practice of plagiarism. All received manuscripts have to pass through "Plagiarism Detection Software" test before forwarding for peer review. We consider "Plagiarism is a crime"

IJCRR Code of Conduct: We at IJCRR voluntarily adopt policies on Code of Conduct, and Code of Ethics given by OASPA and COPE. To know about IJCRRs Code of Conduct, Code of Ethics, Artical Retraction policy, Digital Preservation Policy, and Journals Licence policy click here

Disclaimer: International Journal of Current Research and Review (JICRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



Company name

International Journal of Current Research and Review (JICRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

Contact

148, IMSR Building, Ayurvedic Layout,
        Near NIT Complex, Sakkardara,
        Nagpur-24, Maharashtra State, India

editor@ijcrr.com

editor.ijcrr@gmail.com


Copyright © 2020 IJCRR. Specialized online journals by ubijournal .Website by Ubitech solutions