Santamaría Gorane, Velasco Martín, Farré Xavier, Vanrell Juan Antonio, Cardesa Antonio, Fernández Pedro Luis
Department of Radiology, Hospital Clínic and University of Barcelona Medical School, Villarroel 170, 08036 Barcelona, Spain.
Radiology. 2005 Feb;234(2):374-80. doi: 10.1148/radiol.2342031252. Epub 2004 Dec 15.
To prospectively compare unenhanced power Doppler sonographic findings of arterial vascularization of invasive breast carcinoma with histopathologic and immunohistochemical parameters and to determine whether tumor arterial vascularization contributes to prediction of axillary node status.
Ethics committee approval and informed consent were obtained. A total of 97 invasive breast carcinomas were prospectively studied with unenhanced power Doppler sonography before surgery. Lumpectomy or mastectomy with full axillary nodal dissection was performed. Sonographic tumor size and number of tumor arteries were correlated with axillary nodal status by means of logistic regression analysis. Tumor microvascularization was immunohistochemically assessed in a subset of 55 carcinomas. Sonographic variables were correlated with tumor arteries with a diameter larger than 300 mum and with the density and area of microvascularization. The kappa statistic and Bland-Altman agreement limits were used to measure agreement between techniques.
Good agreement of sonographic and histologic findings regarding number of tumor arteries (kappa= 0.66, P < .001) and tumor size (P = .012) was observed. Multivariate analysis showed an independent relationship between probability of axillary metastasis, number of tumor arteries (P = .016), and sonographic tumor size (P = .035). A predictive model of axillary status was developed. The receiver operating characteristic curve was used to determine 0.2324 as the score to classify axillary nodal status. This score indicated high sensitivity (96.1%), low specificity (53.0%), and high negative predictive value (96.1%).
The number of arteries in invasive breast carcinoma detected with unenhanced power Doppler sonography and sonographic tumor size are independent predictors of axillary nodal status; these variables could contribute to reliable prediction of absence of axillary involvement on the basis of a mathematic model.
前瞻性比较浸润性乳腺癌动脉血管化的未增强功率多普勒超声检查结果与组织病理学和免疫组化参数，并确定肿瘤动脉血管化是否有助于预测腋窝淋巴结状态。
获得伦理委员会批准并取得知情同意。术前对97例浸润性乳腺癌进行前瞻性未增强功率多普勒超声检查。行肿块切除术或乳房切除术并进行全腋窝淋巴结清扫。通过逻辑回归分析将超声检查的肿瘤大小和肿瘤动脉数量与腋窝淋巴结状态相关联。对55例癌的子集进行免疫组化评估肿瘤微血管化。超声变量与直径大于300μm的肿瘤动脉以及微血管化的密度和面积相关联。kappa统计量和Bland-Altman一致性界限用于测量技术之间的一致性。
观察到超声和组织学检查在肿瘤动脉数量（kappa = 0.66，P <.001）和肿瘤大小（P =.012）方面有良好的一致性。多变量分析显示腋窝转移概率、肿瘤动脉数量（P =.016）和超声检查的肿瘤大小（P =.035）之间存在独立关系。建立了腋窝状态的预测模型。使用受试者操作特征曲线确定0.2324作为分类腋窝淋巴结状态的分数。该分数显示出高敏感性（96.1%）、低特异性（53.0%）和高阴性预测值（96.1%）。
未增强功率多普勒超声检查检测到的浸润性乳腺癌中的动脉数量和超声检查的肿瘤大小是腋窝淋巴结状态的独立预测因素；这些变量可有助于基于数学模型可靠地预测无腋窝受累情况。
