Alvarez Soledad, Añorbe Enrique, Alcorta Pilar, López Fernando, Alonso Ignacio, Cortés Julia
Department of Nuclear Medicine, Hospital Santiago Apóstol, Olaguibel 29, 01004 Vitoria, Alava, Spain.
AJR Am J Roentgenol. 2006 May;186(5):1342-8. doi: 10.2214/AJR.05.0936.
The purpose of our study was to evaluate the accuracy of sonography and sonographically guided biopsy in the preoperative diagnosis of metastatic invasion of the axilla in patients with breast carcinoma.
We performed a MEDLINE search (keywords, "sonography" OR "ultrasound" AND "axillary") and a manual search of the references of relevant studies and reviews of preoperative diagnosis on sonography of possible axillary metastases. The gold standard required was axillary lymph node dissection; we accepted sentinel node biopsy as an alternative gold standard. Considering the sonographic findings and the results of the sonographically guided biopsy, the sensitivity and specificity were calculated using metaanalysis. We also checked the existence of heterogeneity of the summary results.
Sixteen articles were selected. In sonography of axillae without palpable nodes, and using lymph node size as the criterion for positivity, sensitivity varied between 48.8% (95% confidence interval, 39.6-58%) and 87.1% (76.1-94.3%) and specificity, between 55.6% (44.7-66.3%) and 97.3% (86.1-99.9%). When lymph node morphology was used as the criterion for positivity, sensitivity ranged from 26.4% (15.3-40.3%) to 75.9% (56.4-89.7%) and specificity, from 88.4% (82.1-93.1%) to 98.1% (90.1-99.9%). The results are different if axillae with palpable nodes are included. The sonographically guided biopsy shows a sensitivity that varies between 30.6% (22.5-39.6%) and 62.9% (49.7-74.8%) and a specificity of 100% (94.8-100%). Many of the summary results obtained after meta-analysis show a heterogeneity that disappears, on occasion, on excluding the studies that use a double gold standard.
Axillary sonography is moderately sensitive and fairly specific in the diagnosis of axillary metastatic involvement. Sonographically guided biopsy of the sonographically suspicious nodes somewhat increases the specificity, which reaches 100%. Negative sonographic results do not exclude axillary lymph node metastases.
本研究旨在评估超声检查及超声引导下活检对乳腺癌患者腋窝转移术前诊断的准确性。
我们进行了MEDLINE检索（关键词：“超声检查”或“超声”以及“腋窝”），并人工检索了相关研究的参考文献以及关于超声检查对可能的腋窝转移术前诊断的综述。所需的金标准是腋窝淋巴结清扫；我们将前哨淋巴结活检作为替代金标准。根据超声检查结果及超声引导下活检的结果，采用荟萃分析计算敏感性和特异性。我们还检查了汇总结果的异质性。
共选取16篇文章。在腋窝无可触及淋巴结的超声检查中，以淋巴结大小作为阳性标准时，敏感性在48.8%（95%置信区间，39.6 - 58%）至87.1%（76.1 - 94.3%）之间，特异性在55.6%（44.7 - 66.3%）至97.3%（86.1 - 99.9%）之间。以淋巴结形态作为阳性标准时，敏感性在26.4%（15.3 - 40.3%）至75.9%（56.4 - 89.7%）之间，特异性在88.4%（82.1 - 93.1%）至98.1%（90.1 - 99.9%）之间。若纳入有可触及淋巴结的腋窝，结果则有所不同。超声引导下活检的敏感性在30.6%（22.5 - 39.6%）至62.9%（49.7 - 74.8%）之间，特异性为100%（94.8 - 100%）。荟萃分析后获得的许多汇总结果显示存在异质性，有时在排除使用双重金标准的研究后异质性消失。
腋窝超声检查在诊断腋窝转移受累方面具有中等敏感性和相当高的特异性。对超声可疑淋巴结进行超声引导下活检可在一定程度上提高特异性，使其达到100%。超声检查结果为阴性并不能排除腋窝淋巴结转移。
