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Possible Association Exists Between Biopsy Method and Incidence of Sentinel Node Metastases in Patients with Invasive Breast Cancer

The incidence of sentinel node metastases was higher in women who underwent fine-needle aspiration or large-gauge needle core biopsy rather than excisional biopsy, suggesting an association between the type of biopsy and the incidence of sentinel node (SN) metastases, according to the findings of a prospective database study.

Between January 1995 and April 1999, 663 patients with invasive, clinically node-negative, biopsy proven breast carcinomas underwent sentinel lymph node dissection. Of the 676 carcinomas overall, diagnosis in 126 was by fine-needle aspiration (FNA), in 227 by large-gauge needle core biopsy, and 323 by excisional biopsy.

"The incidence of SN metastases was 47% in the FNA group, 45% in the large-gauge needle core group, and 32% in the excisional group," reports Nora M. Hansen, MD, Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, United States, and colleagues. "This was not surprising because the size of the primary tumour was larger in the FNA group than the excisional group," the authors note.

Multivariate analyses based on known prognostic factors revealed the incidence of sentinel node metastases was higher in patients who underwent FNA compared with excisional biopsy - odds ratio (OR) 1.531 - and higher among those who underwent large-gauge needle core compared with excisional biopsy - OR 1.484. These associations were independent of age, tumour size, and tumour grade, and the difference was greater and statistically significant in the comparison between large-gauge needle core biopsy and excisional biopsy (P = .04).

Tumour size and grade were also significant prognostic factors for sentinel node metastases, the authors note.

"The results of the present study indicate that the type of biopsy is associated with differences in the incidence of SN metastases," the authors conclude, adding that further investigation is necessary to confirm these findings. "Until this observation can be further evaluated and validated," they note, "we do not plan on changing our practice patterns, which presently incorporate the use of FNA, large-gauge needle core biopsy, and excisional biopsy in the management of breast lesions."

Arch Surg 2004;139:634-640

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