Tahir Mohammad, Osman Khalid A, Shabbir J, Rogers Colin, Suarez Richard, Reynolds Tim, Bucknall Tim
Department of Breast surgery, Queen's Hospital, Queens Hospital Burton on Trent, Staffordshire DE13 0RB, UK.
Breast J. 2008 Jul-Aug;14(4):369-71. doi: 10.1111/j.1524-4741.2008.00600.x.
This study was performed to assess the feasibility and accuracy of ultrasound guided fine needle aspiration biopsy for axillary staging in invasive breast cancer. Data were collected prospectively from June 2005 to June 2006. In all, 197 patients with invasive breast cancer and clinically nonsuspicious axillary lymph nodes were included. Patients with suspicious nodes on ultrasound had fine needle aspiration biopsy. Those with fine needle aspiration biopsy positive for malignancy were planned for axillary nodes clearance otherwise they had sentinel node biopsy. Patients (41) had ultrasound guided fine needle aspiration biopsy. Three cases were excluded for being nonconclusive. Postoperative histology showed 18/38 cases (47.4%) axillary lymph nodes positive and 20/38 cases (52.6%) axillary nodes negative. Ultrasound guided fine needle aspiration biopsy was positive in 8/38 cases (21.1%), negative in 30/38 cases (78.9%). The sensitivity of ultrasound guided fine needle aspiration biopsy was found to be 47.1%, specificity 100%, positive predictability 100%, negative predictability 70%, and overall accuracy 76.3%. Ultrasound guided fine needle aspiration biopsy was found to be more accurate and sensitive when two or more nodes were involved, raising the sensitivity to 80% and negative predictability to 93.3%. Preoperative axillary staging with ultrasound guided fine needle aspiration biopsy in invasive breast cancer patients is very beneficial in diagnosing nodes positive cases. These cases can be planned for axillary lymph nodes clearance straightaway therefore saving patients from undergoing further surgery as well as time and resources.
本研究旨在评估超声引导下细针穿刺活检用于浸润性乳腺癌腋窝分期的可行性和准确性。数据于2005年6月至2006年6月前瞻性收集。总共纳入了197例浸润性乳腺癌且临床腋窝淋巴结无可疑的患者。超声检查发现有可疑淋巴结的患者接受细针穿刺活检。细针穿刺活检结果为恶性阳性的患者计划进行腋窝淋巴结清扫，否则进行前哨淋巴结活检。41例患者接受了超声引导下细针穿刺活检。3例因结果不明确被排除。术后组织学检查显示38例中有18例（47.4%）腋窝淋巴结阳性，20例（52.6%）腋窝淋巴结阴性。超声引导下细针穿刺活检在38例中有8例（21.1%）为阳性，30例（78.9%）为阴性。超声引导下细针穿刺活检的敏感性为47.1%，特异性为100%，阳性预测值为100%，阴性预测值为70%，总体准确率为76.3%。当涉及两个或更多淋巴结时，超声引导下细针穿刺活检更准确、更敏感，敏感性提高到80%，阴性预测值提高到93.3%。对浸润性乳腺癌患者进行术前超声引导下细针穿刺活检腋窝分期，对诊断淋巴结阳性病例非常有益。这些病例可以直接计划进行腋窝淋巴结清扫，从而使患者免于接受进一步手术以及节省时间和资源。
