重新定义腋窝阳性淋巴结的超声表现标准。

Redefining ultrasound appearance criteria of positive axillary lymph nodes.

作者信息

Duchesne Nathalie, Jaffey James, Florack Peggy, Duchesne Simon

机构信息

Department of Radiology, Ottawa Hospital, Ottawa, ON.

出版信息

Can Assoc Radiol J. 2005 Dec;56(5):289-96.

DOI:

PMID:16579022

Abstract

OBJECTIVE

To determine objective criteria for ultrasonography (US) appearance in the diagnosis of abnormal axillary lymph nodes (ALNs) and to assess retrospectively their accuracy in preoperative staging of patients with Breast Imaging Reporting and Data System (BI-RADS) Category 5 breast lesion.

METHODS

US-guided axillary fine-needle aspiration biopsy (FNAB) was performed for preoperative staging of BI-RADS Category 5 lesions in breast cancer patients seen at the Ottawa Regional Women's Breast Health Centre. Retrospectively, ALN morphology was classified into 3 categories based on US appearance: mass-like appearance, focal nodular cortical thickening (FNCT), and diffuse cortical thickening (DCT), the latter 2 with fatty hilum preservation and cortical thickening greater than 2 mm. Cytologic results from the FNAB were compared with axillary lymph node dissection (ALND) or sentinel lymph node procedure (SLNP), when available. Retrospective image-based classification was performed blind to pathology results and analyzed with Pearson's correlation coefficient, receiver operating characteristic (ROC) curves, and chi-square and Hosmer-Lemeshow tests against the cytologic ground truth.

RESULTS

Eighty-six ALNs in 84 patients were sampled with an 18-gauge needle under US guidance. The number of passes per sample was related to adequate sampling of positive ALNs having mass-like morphology but not DCT or FNCT (p < 0.001). The most frequent morphologic presentation of the 86 ALNs was mass-like appearance of lymph nodes (45%), followed by DCT (35%) and FNCT (20%). Metastatic involvement was found in 34 (87%) of 39 ALNs that were mass-like, in 9 (53%) of 17 ALNs with FNCT, and in 9 (30%) of 30 ALNs with DCT. The kappa agreement between FNAB and ALND or SLNP was 0.64 for mass-like lymph nodes, 0.7 for lymph nodes with DCT, and 1.0 for FNCT. Overall sensitivity and specificity were 94% and 89%, respectively, with a positive predictive value of 97% and negative predictive value of 80%.

CONCLUSIONS

Using a 2-mm threshold, FNCT and DCT warrant US-guided FNAB by an experienced radiologist as much as do mass-like lymph nodes. When biopsy is positive, axillary dissection can be performed and the sentinel node technique avoided.

摘要

目的

确定超声检查（US）在诊断异常腋窝淋巴结（ALN）时的客观标准，并回顾性评估其在乳腺影像报告和数据系统（BI-RADS）5类乳腺病变患者术前分期中的准确性。

方法

对在渥太华地区女性乳腺健康中心就诊的乳腺癌患者的BI-RADS 5类病变进行术前分期时，在超声引导下进行腋窝细针穿刺活检（FNAB）。回顾性地根据超声表现将ALN形态分为3类：肿块样表现、局灶性结节状皮质增厚（FNCT）和弥漫性皮质增厚（DCT），后两者脂肪门保留且皮质增厚大于2mm。将FNAB的细胞学结果与腋窝淋巴结清扫术（ALND）或前哨淋巴结手术（SLNP）（如有）的结果进行比较。对病理结果进行盲法回顾性图像分类，并使用Pearson相关系数、受试者操作特征（ROC）曲线以及针对细胞学真实情况的卡方检验和Hosmer-Lemeshow检验进行分析。

结果

在超声引导下，用18号针采集了84例患者的86个ALN。每个样本的穿刺次数与具有肿块样形态而非DCT或FNCT的阳性ALN的充分采样有关（p<0.001）。86个ALN最常见的形态表现是淋巴结肿块样外观（45%），其次是DCT（35%）和FNCT（20%）。在39个肿块样的ALN中，34个（87%）发现有转移累及；在17个FNCT的ALN中，9个（53%）有转移累及；在30个DCT的ALN中，9个（30%）有转移累及。FNAB与ALND或SLNP之间的kappa一致性，肿块样淋巴结为0.64，DCT淋巴结为0.7，FNCT为1.0。总体敏感性和特异性分别为94%和89%，阳性预测值为97%，阴性预测值为80%。