van Rijk Maartje C, Deurloo Eline E, Nieweg Omgo E, Gilhuijs Kenneth G A, Peterse Johannes L, Rutgers Emiel J T, Kröger Robert, Kroon Bin B R
Department of Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX, 1066, The Netherlands.
Ann Surg Oncol. 2006 Jan;13(1):31-5. doi: 10.1245/ASO.2005.01.024. Epub 2006 Jan 1.
Some 30% to 40% of the breast cancer patients scheduled for sentinel node biopsy have axillary metastasis. Pilot studies suggest that ultrasonography is useful in the preoperative detection of such nodes. The aims of this study were to evaluate the sensitivity of preoperative ultrasonography and fine-needle aspiration cytology for detecting axillary metastases and to assess how often sentinel node biopsy could be avoided.
Between October 1999 and December 2003, 726 patients with clinically negative lymph nodes were eligible for sentinel node biopsy. A total of 732 axillae were examined. Preoperative ultrasonography with subsequent fine-needle aspiration cytology in case of suspicious lymph nodes was performed in all patients. The sentinel node procedure was omitted in patients with tumor-positive axillary lymph nodes in lieu of axillary lymph node dissection.
Ultrasound and fine-needle aspiration cytology established axillary metastases in 58 (8%) of the 726 patients. These 58 were 21% of the total of 271 patients who were proven to have axillary metastasis in the end. Of the patients with ultrasonographically suspicious lymph nodes and negative cytology, 31% had tumor-positive sentinel nodes. Patients with preoperatively established metastases by ultrasonography and fine-needle aspiration cytology had more tumor-positive lymph nodes (P < .001) than patients with metastases established later on.
The sensitivity of ultrasonography and fine-needle aspiration cytology is 21%, and unnecessary sentinel node biopsy is avoided in 8% of the patients. This approach improves the selection of patients eligible for sentinel node biopsy.
计划进行前哨淋巴结活检的乳腺癌患者中，约30%至40%存在腋窝转移。初步研究表明，超声检查有助于术前检测此类淋巴结。本研究的目的是评估术前超声检查和细针穿刺细胞学检查检测腋窝转移的敏感性，并评估可避免前哨淋巴结活检的频率。
1999年10月至2003年12月期间，726例临床淋巴结阴性的患者符合前哨淋巴结活检条件。共检查了732个腋窝。所有患者均进行术前超声检查，对可疑淋巴结进行细针穿刺细胞学检查。腋窝淋巴结阳性的患者省略前哨淋巴结手术，改为腋窝淋巴结清扫术。
超声检查和细针穿刺细胞学检查确诊726例患者中有58例（8%）存在腋窝转移。这58例占最终被证实有腋窝转移的271例患者总数的21%。超声检查可疑但细胞学检查阴性的患者中，31%的前哨淋巴结有肿瘤转移。术前经超声检查和细针穿刺细胞学检查确诊有转移的患者，其肿瘤转移阳性淋巴结比后来确诊转移的患者更多（P <.001）。
超声检查和细针穿刺细胞学检查的敏感性为21%，8%的患者可避免不必要的前哨淋巴结活检。这种方法改善了适合前哨淋巴结活检患者的选择。
