Department of Gynecology and Obstetrics, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany.
Ultraschall Med. 2011 Aug;32(4):393-9. doi: 10.1055/s-0029-1245505. Epub 2010 Oct 11.
Rational therapy planning should aim to minimize the rate of axillary lymph node dissection (ALND) in patients without metastatic disease. By the same token, the frequency of sentinel lymph node biopsies (SLNB) should not be unnecessarily high in patients with axillary node disease. Preoperative axillary ultrasonography is a generally available noninvasive technique for assessing nodal status.
Based on retrospective data, we analyzed the sensitivity, specificity, positive and negative predictive value, and efficiency of preoperative ultrasonography US. A total of 429 axillary ultrasonographic examinations were included, and the management decisions were based on the ultrasonographic findings. Patients with suspicious US results were scheduled for ALND, while patients with unremarkable findings underwent SLNB.
Axillary metastases were found in 146 of 429 (34 %) cases. In 75 of 429 (17 %) axillary examinations, ultrasonography revealed suspicious findings. In these cases, we proceeded with ALND, thereby reducing the number of SLNB by 17 %. 219 of 429 cases were classified correctly as not having metastasis, thus lowering the rate of ALND, which is associated with higher postoperative morbidity, by 51 %. Preoperative ultrasonography had a sensitivity of 53.6 %, specificity of 75.5 %, and a positive predictive value of 77.3 %. The negative predictive value was 51.3 % and the efficiency was 68.5 %.
Ultrasonography is a moderately sensitive, but quite specific, preoperative method for assessing the axillary lymph nodes.
合理的治疗计划应旨在降低无转移疾病患者的腋窝淋巴结清扫（ALND）率。同样，对于腋窝淋巴结疾病患者，不应不必要地增加前哨淋巴结活检（SLNB）的频率。术前腋窝超声检查是一种广泛应用的评估淋巴结状态的非侵入性技术。
基于回顾性数据，我们分析了术前超声检查（US）的敏感性、特异性、阳性和阴性预测值以及效率。共纳入 429 例腋窝超声检查，管理决策基于超声检查结果。对超声结果可疑的患者进行 ALND，而对无明显异常的患者进行 SLNB。
429 例中，146 例（34%）发现腋窝转移。429 例腋窝检查中，75 例（17%）超声检查显示可疑发现。在这些情况下，我们进行了 ALND，从而减少了 17%的 SLNB。219 例被正确分类为无转移，从而降低了与更高术后发病率相关的 ALND 率 51%。术前超声检查的敏感性为 53.6%，特异性为 75.5%，阳性预测值为 77.3%。阴性预测值为 51.3%，效率为 68.5%。
超声检查是一种中等敏感但特异性较高的术前评估腋窝淋巴结的方法。
