Hyun S J, Kim E-K, Yoon J H, Moon H J, Kim M J
Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
Clin Radiol. 2015 Jul;70(7):716-22. doi: 10.1016/j.crad.2015.03.004. Epub 2015 Apr 25.
To evaluate whether adding magnetic resonance imaging (MRI) to ultrasound (US) and US-guided fine-needle aspiration (US-FNA) can reduce the false-negative rate (FNR) in the diagnosis of axillary lymph node metastasis (ALNM) in breast cancer patients, and to assess false-negative diagnosis of N2 and N3 disease when adding MRI to US and US-FNA.
From March 2012 to February 2013, 497 breast cancer patients were included in the study. ALNM was evaluated according to US and US-FNA prior to MRI. Second-look US was performed when MRI showed positive findings of ALNM. If second-look US also revealed a positive finding, US-FNA was performed. Diagnostic performance, including FNR, was calculated for US and US-FNA with and without MRI. The negative predictive value (NPV) of N2 and N3 disease was evaluated in negative cases based on US and US-FNA with MRI.
A total of 159 of 497 (32.0%) patients were found to have ALNM. Among them, 92 patients were diagnosed with metastasis on US and US-FNA. When adding MRI to US and US-FNA, an additional six patients were diagnosed with metastasis. The FNR of diagnosis of ALNM was improved by the addition of MRI (42.1% versus 38.4%, p = 0.0143). The NPV for N2 and N3 disease was 98% (391/399) based on US and US-FNA with MRI.
Adding MRI to US and US-FNA could reduce the FNR of the diagnosis of ALNM. Furthermore, US and US-FNA with MRI may exclude 98% of N2 and N3 disease.
评估在超声（US）及超声引导下细针穿刺活检（US-FNA）基础上增加磁共振成像（MRI）检查能否降低乳腺癌患者腋窝淋巴结转移（ALNM）诊断中的假阴性率（FNR），并评估在US及US-FNA基础上增加MRI时N2和N3期疾病的假阴性诊断情况。
2012年3月至2013年2月，497例乳腺癌患者纳入本研究。在进行MRI检查前，先根据US及US-FNA评估ALNM情况。当MRI显示ALNM阳性结果时，进行二次超声检查。若二次超声检查也显示阳性结果，则进行US-FNA。计算有或无MRI检查时US及US-FNA的诊断性能，包括FNR。基于有MRI检查的US及US-FNA，对阴性病例评估N2和N3期疾病的阴性预测值（NPV）。
497例患者中，共159例（32.0%）被发现有ALNM。其中，92例患者经US及US-FNA诊断为转移。在US及US-FNA基础上增加MRI检查后，又有6例患者被诊断为转移。增加MRI检查后，ALNM诊断的FNR有所改善（42.1%对38.4%，p = 0.0143）。基于有MRI检查的US及US-FNA，N2和N3期疾病的NPV为98%（391/399）。
在US及US-FNA基础上增加MRI检查可降低ALNM诊断的FNR。此外，联合MRI检查的US及US-FNA可能排除98%的N2和N3期疾病。
