J Korean Soc Radiol.  2020 Jan;81(1):147-156. 10.3348/jksr.2020.81.1.147.

Diagnostic Value of CYFRA 21-1 Measurement in Fine-Needle Aspiration Washouts for Detection of Axillary Recurrence in Postoperative Breast Cancer Patients

  • 1Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. mines@yuhs.ac


The objective of this study was to evaluate the diagnostic value and threshold levels of cytokeratin fragment 21-1 (CYFRA 21-1) in fine-needle aspiration (FNA) washouts for detection of lymph node (LN) recurrence in postoperative breast cancer patients.
FNA cytological assessments and CYFRA 21-1 measurement in FNA washouts were performed for 64 axillary LNs suspicious for recurrence in 64 post-operative breast cancer patients. Final diagnosis was made on the basis of FNA cytology and follow-up data over at least 2 years. The concentration of CYFRA 21-1 was compared between recurrent LNs and benign LNs. Diagnostic performance and cut-off value were evaluated using a receiver operating characteristic curve.
Regardless of the non-diagnostic results, the median concentration of CYFRA 21-1 in recurrent LNs was significantly higher than that in benign LNs (p < 0.001). The optimal diagnostic cut-off value was 1.6 ng/mL. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CYFRA 21-1 for LN recurrence were 90.9%, 100%, 100%, 98.1%, and 98.4%, respectively.
Measurement of CYFRA 21-1 concentration from ultrasound-guided FNA biopsy aspirates showed excellent diagnostic performance with a cut-off value of 1.6 ng/mL. These results indicate that measurement of CYFRA 21-1 concentration in FNA washouts is useful for the diagnosis of axillary LN recurrence in post-operative breast cancer patients.

MeSH Terms

Biopsy, Fine-Needle*
Breast Neoplasms*
Follow-Up Studies
Lymph Nodes
Postoperative Period
ROC Curve
Sensitivity and Specificity


  • Fig. 1 Concentration of CYFRA 21-1 in FNA washouts from benign and recurrent axillary lymph nodes. CYFRA 21-1 = cytokeratin fragment 21-1, FNA = fine-needle aspiration

  • Fig. 2 ROC curve of CYFRA 21-1 concentration for detecting recurrent axillary LNs when LNs with non-diagnostic results (n = 12) in fine-needle aspiration were considered as benign LNs. CYFRA 21-1 = cytokeratin fragment 21-1, LN = lymph node, ROC = receiver operating characteristics curve


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