Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
Ann Surg. 2011 Aug;254(2):243-51. doi: 10.1097/SLA.0b013e31821f1564.
Systematic evidence synthesis of ultrasound-guided needle biopsy (UNB) of axillary nodes in breast cancer.
Women affected by invasive breast cancer undergo initial staging with sentinel node biopsy, generally progressing to axillary node dissection (AND) if metastases are found. Preoperative UNB can potentially identify and triage women with node metastases directly to AND.
Review and meta-analysis of studies reporting UNB accuracy: we estimated sensitivity, specificity, and PPV, using bivariate random-effects models and examined the effect of covariates; we calculated UNB utility (effect on axillary surgery).
Thirty-one studies provided 2874 UNB data from 6166 subjects (median proportion with metastatic nodes 47.2%; IQR 39.5%, 61.2%). Modeled estimates for UNB were: sensitivity 79.6% (95% confidence intervals [CI] 74.1-84.2), specificity 98.3% (95%CI 97.2-99.0), PPV 97.1% (95%CI 95.2-98.3); median UNB insufficiency was 4.1% (IQR0%-10.9%). UNB sensitivity increased with increasing ultrasound sensitivity, and was higher in studies performing UNB for "suspicious" than for "visible" nodes. Specificity was higher in studies of consecutive (vs. selected) subjects, in studies reporting ultrasound data, and in more recent studies. Median proportion of women triaged directly to AND (attributed to UNB) was 19.8% (IQR11.6%-28.1%) or 17.7% (IQR11.6%-27.1%) if restricted to clinically node-negative series. Median proportion of women with metastatic axillary nodes potentially triaged to AND was 55.2% (IQR41.8%-68.2%) and was higher (65.6%; IQR48.9%-69.7%) in the subgroup of studies with median tumor size ≥21 mm.
Preoperative UNB of the axilla is accurate for initial staging of women with invasive breast cancer. Meta-analysis indicates that UNB provides better utility in women with average or higher underlying risk of node metastases.
系统评价超声引导下腋窝淋巴结活检（UNB）在乳腺癌中的应用。
患有浸润性乳腺癌的女性首先进行前哨淋巴结活检，若发现转移则通常进一步行腋窝淋巴结清扫术（AND）。术前 UNB 可直接识别和筛选出有淋巴结转移的女性，并直接进行 AND。
对报道 UNB 准确性的研究进行综述和荟萃分析：我们使用双变量随机效应模型估计敏感性、特异性和阳性预测值，并检查协变量的影响；计算 UNB 的效用（对腋窝手术的影响）。
31 项研究提供了 6166 例受试者 2874 例 UNB 数据（转移性淋巴结中位数比例为 47.2%；IQR 39.5%，61.2%）。UNB 的模型估计值为：敏感性 79.6%（95%CI 74.1-84.2），特异性 98.3%（95%CI 97.2-99.0），阳性预测值 97.1%（95%CI 95.2-98.3）；UNB 不足的中位数为 4.1%（IQR 0%-10.9%）。UNB 的敏感性随着超声敏感性的增加而增加，对“可疑”淋巴结进行 UNB 的研究比对“可见”淋巴结进行 UNB 的研究敏感性更高。在连续（而非选择）受试者研究中、在报告超声数据的研究中以及在更近的研究中，特异性更高。归因于 UNB 而直接行 AND 的女性比例中位数为 19.8%（IQR 11.6%-28.1%），如果仅纳入临床淋巴结阴性的系列研究，则为 17.7%（IQR 11.6%-27.1%）。潜在可通过 UNB 分诊至 AND 的转移性腋窝淋巴结的女性比例中位数为 55.2%（IQR 41.8%-68.2%），在肿瘤大小中位数≥21mm 的亚组中更高（65.6%；IQR 48.9%-69.7%）。
术前 UNB 对浸润性乳腺癌女性的初始分期准确。荟萃分析表明，在平均或更高淋巴结转移潜在风险的女性中，UNB 具有更好的效用。
