Abe Hiroyuki, Schmidt Robert A, Kulkarni Kirti, Sennett Charlene A, Mueller Jeffrey S, Newstead Gillian M
Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637, USA.
Radiology. 2009 Jan;250(1):41-9. doi: 10.1148/radiol.2493071483. Epub 2008 Oct 27.
To study the clinical usefulness of ultrasonography (US)-guided core-needle biopsy (CNB) of axillary lymph nodes and the US-depicted abnormalities that may be used to predict nodal metastases.
This retrospective study was HIPAA compliant and institutional review board approved; the requirement for informed patient consent was waived. US-guided 14-gauge CNB of abnormal axillary lymph nodes was performed in 100 of 144 patients with primary breast cancer who underwent US assessment of axillary lymph nodes. A biopsy needle with controllable action rather than a traditional throw-type needle was used. US findings were considered suspicious for metastasis if cortical thickening and/or nonhilar blood flow (NHBF) to the lymph node cortex was present. The absence of any discernible fatty hilum was also noted.
Nodal metastases were documented at CNB in 64 (64%) of the 100 patients. All 36 patients with negative biopsy results underwent subsequent sentinel lymph node biopsy (SLNB), which yielded negative findings in 32 (89%) patients and revealed metastasis in four (11%). All 44 patients who did not undergo CNB because of negative US results subsequently underwent SLNB, which revealed lymph node metastasis in 12 (27%) patients. Cortical thickening was found in 63 (79%) of the total of 80 metastatic nodes, but only a minority (n = 26 [32%]) of the nodes had an absent fatty hilum. NHBF to the cortex was detected in 52 (65%) metastatic nodes. Both absence of a fatty hilum (metastasis detected in 26 [93%] of 28 nodes) and cortical thickening combined with NHBF (metastasis detected in 52 [81%] of 64 nodes) had a high positive predictive value. No clinically important complications were encountered with the biopsy procedures.
Axillary lymph nodes with abnormal US findings can be sampled with high accuracy and without major complications by using a modified 14-gauge CNB technique.
研究超声（US）引导下腋窝淋巴结粗针穿刺活检（CNB）的临床实用性以及可用于预测淋巴结转移的US显示异常。
本回顾性研究符合健康保险流通与责任法案（HIPAA）要求并经机构审查委员会批准；无需患者知情同意。对144例接受腋窝淋巴结US评估的原发性乳腺癌患者中的100例进行了US引导下异常腋窝淋巴结14G CNB。使用的是具有可控操作的活检针而非传统的投掷式针。如果存在皮质增厚和/或淋巴结皮质的非门部血流（NHBF），则US检查结果被认为可疑转移。还记录了无任何可辨别的脂肪门部情况。
100例患者中64例（64%）CNB证实有淋巴结转移。所有36例活检结果为阴性的患者随后均接受了前哨淋巴结活检（SLNB），其中32例（89%）结果为阴性，4例（11%）发现转移。所有44例因US结果为阴性而未接受CNB的患者随后均接受了SLNB，其中12例（27%）发现淋巴结转移。80个转移淋巴结中63个（79%）发现皮质增厚，但只有少数（n = 26 [32%]）淋巴结无脂肪门部。52个（65%）转移淋巴结检测到皮质NHBF。无脂肪门部（28个淋巴结中的26个[93%]检测到转移）以及皮质增厚合并NHBF（64个淋巴结中的52个[81%]检测到转移）均具有较高的阳性预测价值。活检操作未出现任何具有临床意义的并发症。
采用改良的14G CNB技术，可对具有异常US表现的腋窝淋巴结进行高精度取材且无重大并发症。
