Department of Radiology, Hacettepe University, Ankara, Turkey.
J Breast Cancer. 2012 Jun;15(2):211-7. doi: 10.4048/jbc.2012.15.2.211. Epub 2012 Jun 28.
We performed this study to detect preoperative axillary metastases with ultrasound (US)-guided fine needle aspiration biopsy (FNAB), to eliminate the need for time-consuming and costly sentinel lymph node (SLN) scintigraphy and biopsy steps in the treatment of breast cancer patients, and in that of with suspicious US findings, and to evaluate the accuracy of preoperative US-guided FNAB for patients with suspicious lymph node metastases on US.
Patients with a suspicious breast lump or histopathologically proven breast cancer underwent breast-axillary US. Increase in lymph node size, cortical thickening, non-hilar cortical flow, and hilar changes were evaluated with gray scale-color Doppler US. FNAB was performed if US results were suspicious for malignancy.
Thirty-eight axillary lymph nodes (ALN) underwent FNAB. ALN dissection, SLN scintigraphy, and biopsy steps were bypassed in 23 axillas with positive ALN FNAB (60.5%). The sensitivity of ALN FNAB was 88.46%; specificity and positive predictive value were 100%; and negative predictive value was 66.6% (inadequate cytology included; 76.7%, 100%, 100%, 53.3%, respectively). Asymmetrical cortical thickening, non-hilar cortical flow, and increase in hypoechogenity were only detected in metastatic nodes. Cortical thickening, and lymph node and breast mass size was higher in the metastatic group.
By performing FNAB on suspicious lymph nodes, the routine, high-cost SLN scintigraphy and intraoperative gamma probe steps may be skipped, and axilla dissection can be performed directly. This leads to the elimination of the need for SLN investigation in more than half of the patients. The assessment of ALN metastases with preoperative US-guided FNAB is a cost-effective method with high specificity, that eliminates the need for costly and time-consuming SLN scintigraphy and biopsy steps, and helps in preoperative staging.
本研究旨在通过超声（US）引导下的细针抽吸活检（FNAB）检测术前腋窝转移，避免在乳腺癌患者和有可疑 US 发现的患者的治疗中进行耗时且昂贵的前哨淋巴结（SLN）闪烁显像和活检步骤，并评估术前 US 引导下 FNAB 对 US 提示可疑淋巴结转移患者的准确性。
对有可疑乳腺肿块或组织病理学证实的乳腺癌患者进行乳腺-腋窝 US 检查。使用灰阶-彩色多普勒 US 评估淋巴结大小增大、皮质增厚、非门控皮质血流和门控改变。如果 US 结果可疑恶性，则进行 FNAB。
38 个腋窝淋巴结（ALN）进行了 FNAB。23 个 ALN FNAB 阳性的腋窝跳过了 ALN 解剖、SLN 闪烁显像和活检步骤（60.5%）。ALN FNAB 的敏感性为 88.46%；特异性和阳性预测值均为 100%；阴性预测值为 66.6%（包括不充分的细胞学；分别为 76.7%、100%、100%、53.3%）。仅在转移性淋巴结中检测到不对称性皮质增厚、非门控皮质血流和低回声增加。在转移性组中，皮质增厚、淋巴结和乳腺肿块大小更高。
对可疑淋巴结进行 FNAB，可以跳过常规的、高成本的 SLN 闪烁显像和术中伽马探针步骤，直接进行腋窝解剖。这导致超过一半的患者无需进行 SLN 检查。术前 US 引导下 FNAB 评估 ALN 转移是一种具有高特异性的经济有效的方法，可消除昂贵且耗时的 SLN 闪烁显像和活检步骤，并有助于术前分期。
