Jackson Rubie Sue, Mylander Charles, Rosman Martin, Andrade Reema, Sawyer Kristen, Sanders Thomas, Tafra Lorraine
The Breast Center, Anne Arundel Medical Center, Annapolis, MD, USA,
Ann Surg Oncol. 2015 Oct;22(10):3289-95. doi: 10.1245/s10434-015-4717-7. Epub 2015 Jul 30.
Axillary lymph node stage is important in guiding adjuvant treatment for breast cancer. The role of axillary ultrasound (AUS) in axillary staging is uncertain.
From an institutional database, all newly diagnosed invasive breast carcinomas from February 1, 2011 to October 31, 2014 were identified; exclusions were for stage IV disease, palpable adenopathy, or receipt of neoadjuvant chemotherapy. AUS findings, categorized as suspicious versus not suspicious, were correlated with the number of nodal metastasis from surgical pathology. The false-negative rate of nonsuspicious AUS for identifying ≥3 lymph nodes positive on final pathology was calculated.
A total of 513 cancers were included. Overall, 400 AUSs were not suspicious (78%), and 113 were suspicious (22%). The sensitivity and specificity of AUS for predicting ≥3 nodal metastasis were 71 and 83%, respectively. The false-negative rate for detecting ≥3 nodal metastasis was 4%. False-negative rate was higher for lobular versus nonlobular carcinomas (12.0 vs. 2.3%, p = 0.004) and for pT2-pT4 tumors versus pT1 tumors (8.2 vs. 1.7 %, p = 0.005).
Patients with normal axillary physical exam and ultrasound rarely harbor a large nodal disease burden. Randomized trials of sentinel lymph node biopsy versus no axillary surgery in patients with normal AUS must be powered for subgroup analysis of patients with invasive lobular carcinoma and pT2-pT4 tumors. Preoperative identification of nodal metastasis may decrease the need for second surgeries and identify candidates for neoadjuvant chemotherapy. AUS is a noninvasive means of predicting disease burden preoperatively and as such is a powerful tool to individualize treatment plans.
腋窝淋巴结分期对于指导乳腺癌的辅助治疗至关重要。腋窝超声（AUS）在腋窝分期中的作用尚不确定。
从机构数据库中识别出2011年2月1日至2014年10月31日期间所有新诊断的浸润性乳腺癌；排除标准为IV期疾病、可触及的腺病或接受过新辅助化疗。将AUS检查结果分为可疑和非可疑，并与手术病理的淋巴结转移数量进行关联。计算非可疑AUS在最终病理检查中识别≥3个阳性淋巴结的假阴性率。
共纳入513例癌症患者。总体而言，400例AUS检查结果为非可疑（78%），113例为可疑（22%）。AUS预测≥3个淋巴结转移的敏感性和特异性分别为71%和83%。检测≥3个淋巴结转移的假阴性率为4%。小叶癌与非小叶癌的假阴性率更高（12.0%对2.3%，p = 0.004），pT2 - pT4肿瘤与pT1肿瘤的假阴性率也更高（8.2%对1.7%，p = 0.005）。
腋窝体格检查和超声正常的患者很少有大量淋巴结疾病负担。对于AUS正常的患者，前哨淋巴结活检与不进行腋窝手术的随机试验必须有足够的样本量，以便对浸润性小叶癌和pT2 - pT4肿瘤患者进行亚组分析。术前识别淋巴结转移可能会减少二次手术的需求，并确定新辅助化疗的候选者。AUS是术前预测疾病负担的一种非侵入性方法，因此是制定个体化治疗方案的有力工具。
