Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2013;8(2):e57248. doi: 10.1371/journal.pone.0057248. Epub 2013 Feb 25.
To assess whether the value of CYFRA21-1 in the aspirates of ultrasonography-guided fine-needle aspiration biopsy (US-FNAB) can contribute to improving the performances of US-FNAB in the diagnosis of axillary lymph node (LN) metastasis in breast cancer patients.
US-FNAB was performed in 156 axillary LNs in 152 breast cancer patients (mean age: 51.4 years, range: 17-92 years). Concentrations of CYFRA21-1 were measured from washouts of the syringe used during US-FNAB. Tumor marker concentrations, US-FNAB, intraoperative sentinel node biopsy (SNB), and surgical pathology results were reviewed and analyzed. For comparison, the values of CEA and CA15-3 were also measured from washouts.
Among the 156 LNs, 75 (48.1%) were benign, and 81 (51.9%) were metastases. Mean concentrations of CYFRA21-1 were significantly higher in metastasis compared to benign LNs (P<0.001). US-FNAB combined to CYFRA21-1 showed significantly higher sensitivity, NPV, and accuracy compared to US-FNAB alone (all values P<0.05). All diagnostic indices of US-FNAB combined to CYFRA21-1 were significantly higher compared to US-FNAB combined with CEA or CA15-3 (all P<0.001). Of the 28 metastatic LNs which showed metastasis on SNB, CYFRA21-1 showed higher positive rate of 75.0% (CEA or CA15-3∶60.7%, P = 0.076).
Measuring CYFRA 21-1 concentrations from US-FNAB aspirates improves sensitivity, NPV, and accuracy of US-FNAB alone, and may contribute to reducing up to 75.0% of unnecessary intraoperative SNB. Compared to CEA or CA15-3, CYFRA21-1 shows significantly higher performances when combined to US-FNAB in the preoperative diagnosis of LN metastasis in breast cancer patients.
评估超声引导下细针抽吸活检（US-FNAB）抽吸液中细胞角蛋白 19 片段（CYFRA21-1）的价值是否有助于提高 US-FNAB 对乳腺癌患者腋窝淋巴结（LN）转移的诊断性能。
对 152 例乳腺癌患者的 156 个腋窝 LN 进行 US-FNAB，患者平均年龄为 51.4 岁（范围：17-92 岁）。从 US-FNAB 所用注射器的冲洗液中测量 CYFRA21-1 浓度。回顾和分析肿瘤标志物浓度、US-FNAB、术中前哨淋巴结活检（SNB）和手术病理结果。为了比较，也从冲洗液中测量了 CEA 和 CA15-3 的值。
在 156 个 LN 中，75 个（48.1%）为良性，81 个（51.9%）为转移。与良性 LN 相比，转移 LN 中 CYFRA21-1 的浓度明显更高（P<0.001）。与单独 US-FNAB 相比，US-FNAB 联合 CYFRA21-1 显示出更高的敏感性、阴性预测值和准确性（所有 P 值<0.05）。与 US-FNAB 联合 CEA 或 CA15-3 相比，US-FNAB 联合 CYFRA21-1 的所有诊断指标均显著更高（所有 P 值<0.001）。在 28 个在 SNB 上显示转移的转移性 LN 中，CYFRA21-1 的阳性率为 75.0%（CEA 或 CA15-3：60.7%，P=0.076）。
从 US-FNAB 抽吸液中测量 CYFRA21-1 浓度可提高单独 US-FNAB 的敏感性、阴性预测值和准确性，并可能有助于减少多达 75.0%的不必要的术中 SNB。与 CEA 或 CA15-3 相比，在乳腺癌患者 LN 转移的术前诊断中，CYFRA21-1 与 US-FNAB 联合时具有显著更高的性能。
