Popli M B, Sahoo M, Mehrotra N, Choudhury M, Kumar A, Pathania O P, Thomas S
Health Center, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
Australas Radiol. 2006 Apr;50(2):122-6. doi: 10.1111/j.1440-1673.2006.01545.x.
Axillary lymph node (ALN) status is considered to be the single most important prognostic indicator in patients with breast cancer. It can be assessed by various radiological, pathological and surgical techniques, the most accurate being histological examination of lymph nodes after axillary lymph node dissection (ALND). This prospective study was conducted to assess the feasibility and diagnostic accuracy of preoperative ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (USG-FNAC) of ALN in patients with breast cancer. Thirty patients with FNAC-proven breast cancer, planned for definitive surgery with axillary clearance, were included in this study. Ultrasonographic evaluation of the axillae of these patients was conducted for alterations in size, shape, contour and cortical morphology of lymph nodes that could reflect presence of underlying metastases. Ultrasound-guided fine-needle aspiration cytology of the ALN was done in 24 of these patients. These findings were evaluated, with the ALN status determined by histological examination after ALND. Out of the 30 patients, eight had T(1), 16 had T(2), five had T(3), and one had T(4) lesions. Ultrasound evaluation of the ALN had a sensitivity of 86.3%, a specificity of 41.6%, a positive predictive value of 79%, a negative predictive value of 50% and a diagnostic accuracy of 73.3%. Sensitivity of USG-FNAC was 78.95%, specificity was 100%, positive predictive value was 100%, negative predictive value was 55.56% and diagnostic accuracy was 83.33%. Our study concludes that preoperative USG-FNAC of ALN is a simple, minimally invasive, easily available and reliable technique for the initial determination of ALN status in patients with breast cancer. Those who are USG-FNAC positive can be directed towards ALND straight away, and only those who are USG-FNAC negative should be considered for sentinel lymph node biopsy. This will save considerable operating time, especially where facilities for sentinel lymph node biopsy (costly dye, gamma camera, nuclear medicine facilities) are restricted or not available.
腋窝淋巴结（ALN）状态被认为是乳腺癌患者最重要的单一预后指标。它可以通过各种放射学、病理学和外科技术进行评估，其中最准确的是腋窝淋巴结清扫术（ALND）后对淋巴结进行组织学检查。本前瞻性研究旨在评估术前超声（US）和超声引导下细针穿刺细胞学检查（USG-FNAC）对乳腺癌患者腋窝淋巴结的可行性和诊断准确性。本研究纳入了30例经细针穿刺活检证实为乳腺癌且计划进行根治性手术并清扫腋窝的患者。对这些患者的腋窝进行超声评估，观察淋巴结大小、形状、轮廓和皮质形态的改变，以反映潜在转移的存在。其中24例患者进行了超声引导下腋窝淋巴结细针穿刺细胞学检查。这些结果与ALND后组织学检查确定的ALN状态进行了评估。30例患者中，8例为T(1)期，16例为T(2)期，5例为T(3)期，1例为T(4)期病变。腋窝淋巴结超声评估的敏感性为86.3%，特异性为41.6%，阳性预测值为79%，阴性预测值为50%，诊断准确性为73.3%。超声引导下细针穿刺细胞学检查的敏感性为78.95%，特异性为100%，阳性预测值为100%，阴性预测值为55.56%，诊断准确性为83.33%。我们的研究得出结论，术前对腋窝淋巴结进行超声引导下细针穿刺细胞学检查是一种简单、微创、易于获得且可靠的技术，可用于初步确定乳腺癌患者的腋窝淋巴结状态。超声引导下细针穿刺细胞学检查阳性的患者可直接进行腋窝淋巴结清扫术，只有超声引导下细针穿刺细胞学检查阴性的患者才应考虑进行前哨淋巴结活检。这将节省大量手术时间，特别是在前哨淋巴结活检设施（昂贵的染料、伽马相机、核医学设施）受限或无法获得的情况下。
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