Reyna Chantal, Kiluk John V, Frelick Anne, Khakpour Nazanin, Laronga Christine, Lee Marie Catherine
Comprehensive Breast Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
J Surg Oncol. 2015 Jun;111(7):813-8. doi: 10.1002/jso.23885. Epub 2015 Mar 8.
Preoperative axillary ultrasound (AUS) in clinically node-negative patients may increase axillary lymph node dissection (ALND) in ACoSOG Z0011-eligible patients. We hypothesize that AUS identifies operative axillary disease (>3 positive nodes) in women undergoing breast conserving surgery (BCS).
After IRB approval, a retrospective review of female breast cancer patients was performed; patients with clinical T1/T2 tumors undergoing BCS were included. Clinical, radiologic, and pathologic data were collected.
Of 139 eligible subjects, 119/139 (86%) had nonpalpable axillary nodes. 47/119 patients (40%) had abnormal AUS and 15/47 (32%) had a positive FNA. Fourteen had ALND ;10/14 (71%) had >3 positive nodes. 6/32 (18%) with abnormal AUS but FNA negative were sentinel lymph node (SLN) positive. Of 72 normal AUS, 15 (22%) were SLN positive; 9/15 (60%) had ALND; 1 (11%) had >3 positive nodes. When evaluating for >3 positive nodes, AUS plus FNA had a sensitivity of 91%, specificity of 95%, NPV of 99%, and PPV of 71%.
AUS/FNA has a high NPV for axillary metastasis and remarkable sensitivity for three or more positive axillary nodes, therefore AUS-identified metastasis should be treated as clinically node-positive disease, and is appropriate even in patients planning breast conserving surgery.
临床腋窝淋巴结阴性患者术前行腋窝超声检查（AUS）可能会增加符合美国外科医师学会肿瘤学组（ACOSOG）Z0011试验标准患者的腋窝淋巴结清扫术（ALND）。我们推测，AUS可识别接受保乳手术（BCS）女性的手术腋窝疾病（3个以上阳性淋巴结）。
经机构审查委员会（IRB）批准后，对女性乳腺癌患者进行回顾性研究；纳入临床T1/T2期肿瘤且接受BCS的患者。收集临床、影像学和病理数据。
139例符合条件的受试者中，119/139例（86%）腋窝淋巴结不可触及。47/119例患者（40%）AUS异常，15/47例（32%）细针穿刺抽吸活检（FNA）阳性。14例接受了ALND；10/14例（71%）有3个以上阳性淋巴结。6/32例（18%）AUS异常但FNA阴性的患者前哨淋巴结（SLN）阳性。72例AUS正常的患者中，15例（22%）SLN阳性；9/15例（60%）接受了ALND；1例（11%）有3个以上阳性淋巴结。在评估3个以上阳性淋巴结时，AUS联合FNA的敏感性为91%，特异性为95%，阴性预测值为99%，阳性预测值为71%。
AUS/FNA对腋窝转移具有较高的阴性预测值，对3个或更多阳性腋窝淋巴结具有显著的敏感性，因此，AUS识别的转移应被视为临床腋窝淋巴结阳性疾病，即使对于计划接受保乳手术的患者也是合适的。
