Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2011 Mar;18(3):738-44. doi: 10.1245/s10434-010-1347-y. Epub 2010 Oct 2.
To evaluate the accuracy of preoperative ultrasonography (US) and US-guided fine-needle aspiration (US-FNA) for detecting axillary lymph node (ALN) metastasis.
We retrospectively reviewed 382 breast cancer patients with clinically negative ALN who underwent US and/or US-FNA for ALN. US-FNA of ALN was performed in 121 patients with suspicious findings on US. The diagnostic performance of US alone or with the addition of US-FNA for detecting ALN metastasis was calculated on the basis of final pathologic reports of ALN surgery.
Among a total of 382 patients, 129 had metastatic ALNs while 253 exhibited no signs of axillary metastasis on final pathology. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of axillary US alone were 56.6% (73/129), 81.0% (205/253), 60.3% (73/121), and 78.5% (205/261), respectively. Addition of US-FNA resulted in sensitivity, specificity, PPV, and NPV of 39.5% (51/129), 95.7% (242/253), 82.3% (51/62), and 75.6% (242/320), respectively. Excluding complete responders to neoadjuvant chemotherapy, specificity and PPV after adding US-FNA were increased to 99.6% (242/243) and 98.1% (51/52), respectively. The sensitivity and specificity of ALN metastasis were similar between the palpable and nonpalpable breast cancer groups; however, after adding US-FNA, NPV was increased in the nonpalpable breast cancer group compared with the palpable breast cancer group (p = 0.0398). By including preoperative axillary US and US-FNA, 16.2% (62/382) of all breast cancer patients were able to avoid unnecessary sentinel lymph node biopsy (SLNB).
The combination of axillary US and US-FNA is useful in preoperative work-up of breast cancer patients and provides valuable information for planning proper breast cancer management.
评估术前超声（US）和 US 引导下细针抽吸（US-FNA）检测腋窝淋巴结（ALN）转移的准确性。
我们回顾性分析了 382 例临床腋窝淋巴结阴性的乳腺癌患者，这些患者均接受了 ALN 的 US 和/或 US-FNA 检查。对 121 例 US 检查有可疑发现的患者进行了 ALN-US-FNA。根据 ALN 手术的最终病理报告，计算了仅行 US 或 US 联合 US-FNA 检查对检测 ALN 转移的诊断性能。
在总共 382 例患者中，有 129 例患者的 ALN 存在转移，而 253 例患者的最终病理检查未见腋窝转移的迹象。单独进行腋窝 US 的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 56.6%（73/129）、81.0%（205/253）、60.3%（73/121）和 78.5%（205/261）。添加 US-FNA 后，敏感性、特异性、PPV 和 NPV 分别为 39.5%（51/129）、95.7%（242/253）、82.3%（51/62）和 75.6%（242/320）。排除新辅助化疗完全缓解的患者后，添加 US-FNA 后的特异性和 PPV 分别提高至 99.6%（242/243）和 98.1%（51/52）。可触及和不可触及乳腺癌组的 ALN 转移的敏感性和特异性相似；然而，添加 US-FNA 后，不可触及乳腺癌组的 NPV 高于可触及乳腺癌组（p=0.0398）。通过包括术前腋窝 US 和 US-FNA，382 例乳腺癌患者中有 16.2%（62/382）可以避免不必要的前哨淋巴结活检（SLNB）。
腋窝 US 和 US-FNA 的联合应用有助于乳腺癌患者的术前检查，并为制定适当的乳腺癌管理方案提供有价值的信息。
