体格检查、超声以及超声联合细针穿刺对原发性乳腺癌腋窝分期的效能

Efficacy of physical examination, ultrasound, and ultrasound combined with fine-needle aspiration for axilla staging of primary breast cancer.

作者信息

Feng Yu, Huang Rui, He Yingjian, Lu Aiping, Fan Zhaoqing, Fan Tie, Qi Meng, Wang Xinguang, Cao Wei, Wang Xing, Xie Yuntao, Wang Tianfeng, Li Jinfeng, Ouyang Tao

机构信息

Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Centre, Peking University Cancer Hospital & Institute, Beijing, 100142, China.

出版信息

Breast Cancer Res Treat. 2015 Feb;149(3):761-5. doi: 10.1007/s10549-015-3280-z. Epub 2015 Feb 10.

DOI:10.1007/s10549-015-3280-z

PMID:25667099

Abstract

The aim of this study was to compare the efficacy of physical examination (PE), ultrasound (US), and US combined with fine-needle cytology (US-FNAC) in evaluation of node status before sentinel lymph node biopsy (SLNB) for breast cancer patients. We performed a retrospective study of 3,781 breast cancer patients and calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for PE, US, and US-FNAC, respectively. A total of 3,175 cases were documented as cN0 and 606 as cN1. Abnormal axillary nodes under US were detected in 1,152 cases, among which 821 were proven to have positive nodes by FNAC. The positive FNAC results enabled 11.7% of cN0 patients (373/3,175) to avoid unnecessary SLNB. All 331 cases with abnormal US but negative FNAC results, and the 2,629 cases with normal US underwent SLNB procedure for nodal staging, and metastatic nodes were identified in 745 patients. The sensitivity of PE was 32.2%, with a specificity of 95.5%, a PPV of 83.5%, a NPV of 65%, and an accuracy of 69.3%. The sensitivity, specificity, PPV, NPV, and accuracy of axillary US alone were 58.6, 89.4, 79.6, 75.3, and 76.7%, respectively. Combining axillary US with FNAC resulted in sensitivity, specificity, PPV, NPV, and accuracy of 52.4, 100, 100, 74.8, and 80.3%, respectively. Our study demonstrated that US-FNAC is a feasible and effective triage during axillary staging for newly diagnosed breast cancer patients.

摘要

本研究的目的是比较体格检查（PE）、超声（US）以及超声联合细针细胞学检查（US-FNAC）在乳腺癌患者前哨淋巴结活检（SLNB）前评估淋巴结状态的疗效。我们对3781例乳腺癌患者进行了一项回顾性研究，并分别计算了PE、US和US-FNAC的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。共有3175例记录为cN0，606例为cN1。超声检查发现腋窝异常淋巴结1152例，其中821例经细针穿刺活检证实为阳性淋巴结。细针穿刺活检阳性结果使11.7%的cN0患者（373/3175）避免了不必要的前哨淋巴结活检。所有331例超声异常但细针穿刺活检结果为阴性的病例，以及2629例超声正常的病例均接受了前哨淋巴结活检以进行淋巴结分期，745例患者发现有转移淋巴结。体格检查的敏感性为32.2%，特异性为95.5%，阳性预测值为83.5%，阴性预测值为65%，准确性为69.3%。单纯腋窝超声的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为58.6%、89.4%、79.6%、75.3%和76.7%。腋窝超声联合细针穿刺活检的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为52.4%、100%、100%、74.8%和80.3%。我们的研究表明，对于新诊断的乳腺癌患者，超声联合细针穿刺活检在腋窝分期中是一种可行且有效的筛选方法。