Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, and Institute of Radiation Medicine, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.
AJR Am J Roentgenol. 2009 Dec;193(6):1731-7. doi: 10.2214/AJR.09.3122.
The purpose of this study was to prospectively evaluate the role of axillary lymph node classification by sonography in breast cancer patients by node-to-node correlation with surgical histology and sentinel node biopsy results.
Between June 2006 and December 2006, preoperative axillary sonography was performed in 191 consecutive breast cancer patients (median age, 46 years; age range, 24-79 years) who had been scheduled to undergo breast cancer surgery with sentinel node biopsy. The axillary lymph node that had the thickest cortex or that was closest to the primary tumor was prospectively classified and then removed through sonographically guided needle localization. Correspondence about and histologic results for the needle-localized nodes and the radioactive sentinel nodes were analyzed. The rate of malignancy, according to the sonographic classification, and the area under a receiver operating characteristic curve were analyzed.
Of the 191 needle-localized nodes, 41 (21%) had metastases and 150 (79%) did not have metastases. When a cutoff point of a cortical thickness of 2.5 mm was used, sonographic classification showed 85% (35/41) sensitivity, 78% (117/150) specificity, and an area under the curve of 0.861 (95% CI, 0.796-0.926). Of the 54 patients with metastases at sentinel node biopsy or axillary lymph node dissection, 13 (24%) had false-negative results of sonographically guided needle localization. Unsuccessful lymphatic mapping because of absent radiotracer uptake during sentinel node biopsy was found in 4% (7/191), whereas all needle-localized nodes with a cortical thickness of more than 2.5 mm were confirmed as metastases.
Sonographic classification of axillary lymph nodes is effective for predicting the presence of metastases to avoid sentinel node biopsy or to reduce unsuccessful lymphatic mapping during sentinel node biopsy.
本研究前瞻性评估超声腋窝淋巴结分类在乳腺癌患者中的作用，通过与手术组织学和前哨淋巴结活检结果的节点对节点相关性进行评估。
2006 年 6 月至 2006 年 12 月期间，对 191 例拟行乳腺癌手术和前哨淋巴结活检的乳腺癌患者进行了术前腋窝超声检查（中位年龄 46 岁；年龄范围 24-79 岁）。对皮质最厚或最接近原发性肿瘤的腋窝淋巴结进行前瞻性分类，然后通过超声引导下的针定位切除。分析了针定位淋巴结和放射性前哨淋巴结的相关性和组织学结果。根据超声分类，分析了恶性肿瘤的发生率和接受者操作特征曲线下的面积。
在 191 个针定位淋巴结中，41 个（21%）有转移，150 个（79%）没有转移。当使用皮质厚度 2.5mm 的截止点时，超声分类的敏感性为 85%（35/41），特异性为 78%（117/150），曲线下面积为 0.861（95%CI，0.796-0.926）。在 54 例前哨淋巴结活检或腋窝淋巴结清扫有转移的患者中，13 例（24%）超声引导下针定位有假阴性结果。由于前哨淋巴结活检期间放射性示踪剂摄取缺失而导致淋巴示踪失败的发生率为 4%（7/191），而所有皮质厚度大于 2.5mm 的针定位淋巴结均被证实为转移。
超声腋窝淋巴结分类对预测转移的存在有效，可避免前哨淋巴结活检或减少前哨淋巴结活检期间淋巴示踪失败。
