Breast Imaging Center, Radiology Department, Hospital Universitario Reina Sofia, Avda. Menendez Pidal s/n, 14004 Cordoba, Spain.
Eur J Radiol. 2011 Jul;79(1):64-72. doi: 10.1016/j.ejrad.2009.12.011. Epub 2010 Jan 4.
Preoperative diagnosis of axillary metastases in breast cancer patients enables treatment planning. We aimed to evaluate the diagnostic accuracy of axillary ultrasonography and percutaneous biopsy, both alone and in combination, in detecting axillary metastases in patients with breast cancer and to assess the impact of these techniques on the patients' management.
Retrospective study of consecutive patients with suspected breast cancer examined between October 2006 and December 2008. The diagnosis of a primary tumor was histologically confirmed in all patients. All patients underwent axillary ultrasonography and percutaneous core biopsy (14 G) of suspicious lymph nodes. We evaluated the morphological characteristics of the lymph nodes by ultrasonography. We calculated the diagnostic accuracy of ultrasonography and of core biopsy, and assessed the impact of these techniques on patients' treatment.
We evaluated 675 axillary regions and performed 291 core biopsies of axillary lymph nodes in 662 patients. In 650 patients, breast cancer was histologically confirmed and in 12 patients malignant tumors in other locations were confirmed. The sensitivity and specificity of axillary ultrasonography were 63.2% and 88.7%, respectively. The absence of a fatty hilum within the lymph node was the ultrasonographic finding with the highest positive predictive value for malignancy (93.1%). The sensitivity and specificity of axillary core biopsy were 69.1% and 100%, respectively. Sentinel lymph node biopsy was avoided in 33% of initial candidates and immediate breast reconstruction was undertaken in 35.1% of the patients with mastectomy and negative axillary core biopsy.
Ultrasonography and axillary core biopsy enable adequate pretreatment staging in patients with breast cancer and has a positive impact on their management.
评估术前超声和经皮穿刺活检单独及联合应用在乳腺癌患者腋窝转移诊断中的准确性，以及这些技术对患者管理的影响。
回顾性分析 2006 年 10 月至 2008 年 12 月间连续就诊的疑似乳腺癌患者，所有患者均经组织学证实存在原发性肿瘤。所有患者均行腋窝超声和可疑淋巴结经皮穿刺核心活检（14G），超声评估淋巴结形态学特征，计算超声和核心活检的诊断准确性，并评估这些技术对患者治疗的影响。
共评估 675 个腋窝区，对 662 例患者的 291 个腋窝淋巴结进行了核心活检。在 650 例患者中，经组织学证实存在乳腺癌，12 例患者存在其他部位的恶性肿瘤。腋窝超声的灵敏度和特异度分别为 63.2%和 88.7%。淋巴结内无脂肪门是超声检查对恶性肿瘤具有最高阳性预测值的表现（93.1%）。腋窝核心活检的灵敏度和特异度分别为 69.1%和 100%。33%的初始候选患者避免了前哨淋巴结活检，35.1%的腋窝核心活检阴性的乳腺癌患者行乳房切除术和即刻乳房重建。
术前超声和腋窝核心活检能为乳腺癌患者提供充分的术前分期，并对其管理具有积极影响。
