超声引导下核心针活检对可疑淋巴结阳性乳腺癌患者前哨淋巴结活检的影响。

Impact of sentinel lymph node biopsy by ultrasound-guided core needle biopsy for patients with suspicious node positive breast cancer.

机构信息

Division of Breast Surgery, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, 260-8717, Japan.

Division of Diagnostic Pathology, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, 260-8717, Japan.

出版信息

Breast Cancer. 2018 Jan;25(1):86-93. doi: 10.1007/s12282-017-0795-7. Epub 2017 Jul 22.

DOI:10.1007/s12282-017-0795-7

PMID:28735457

Abstract

PURPOSE

The purpose of this study was to investigate the accuracy of preoperative diagnostic tools for axillary lymph nodes (LNs) staging of breast cancer.

MATERIALS AND METHODS

A total of 2464 consecutive patients with operable breast cancer were prospectively identified at our institution between April 2012 and March 2017. Patients with suspicious axillary LN of breast cancer were assessed using preoperative ultrasound(US) or computed tomography (CT), underwent fine-needle aspiration cytology (FNA) or core needle biopsy (CNB). The inclusion criteria for both FNA and CNB were a cortical thickness >3 mm or abnormal morphological characteristics. Patients with biopsy-proven metastasis underwent axillary lymph node dissection (ALND), and those with a negative FNA or CNB underwent sentinel lymph node biopsy (SNB). If the SNB was positive, ALND was performed. Diagnostic accuracy for SNB was calculated for both FNA and CNB. In addition, the patients in this study were divided into two groups as follows: the cN0-FNA group (suspicious LN but negative FNA) and cN0-CNB group (suspicious LN but negative CNB).

RESULTS

A number of patients with negative US/CT findings of LNs were 1406, with 744 undergoing FNA and 272 undergoing CNB for suspicious LNs. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 65, 99, 99, 80, and 85% in FNA, and 87, 100, 100, 93 and 95% in CNB, respectively. SNB was performed in 172 (cN0-CNB group) of 272 CNB and 487 (cN0-FNA group) of 744 FNA patients. One hundred and seventy-two patients from the cN0-CNB group (Tis 6, T1 97, T2 66, T3 3 patients) treated with SNB were compared to 487 from the cN0-FNA group (Tis 21, T1 225, T2 233, T3 8 patients) in terms of number of LN metastasis. A number of patients with more than 3 positive SNB and positive LNs were 9 (5%) and 0 (0%) in cN0-CNB group, and 78 (16%) and 24 (5%) in cN0-FNA group, respectively. A number of patients who had complications such as haematoma and pain at the time of 7 to 14 days after CNB and FNA were 1 (0.5%) and 1 (0.5%) in cN0-CNB group, and were 0% and 0.2% in cN0-FNA group (p = 0.44), respectively.

CONCLUSIONS

The preoperative diagnosis of axillary LNs was influenced by the diagnostic tool used. CNB is a reliable method for the preoperative diagnosis of LN metastasis.

摘要

目的

本研究旨在探讨术前诊断工具在乳腺癌腋窝淋巴结（LNs）分期中的准确性。

材料和方法

2012 年 4 月至 2017 年 3 月，我院前瞻性地确定了 2464 例可手术治疗的乳腺癌患者。术前对可疑乳腺癌腋窝 LNs 的患者进行超声（US）或计算机断层扫描（CT）检查，行细针抽吸细胞学（FNA）或核心针活检（CNB）。FNA 和 CNB 的纳入标准均为皮质厚度＞3mm 或异常形态特征。活检证实有转移的患者行腋窝淋巴结清扫术（ALND），FNA 或 CNB 阴性的患者行前哨淋巴结活检术（SNB）。如果 SNB 阳性，则行 ALND。计算 FNA 和 CNB 对 SNB 的诊断准确性。此外，本研究中的患者分为两组：cN0-FNA 组（可疑 LNs 但 FNA 阴性）和 cN0-CNB 组（可疑 LNs 但 CNB 阴性）。

结果

1406 例患者 US/CT 检查 LNs 阴性，其中 744 例行 FNA，272 例行可疑 LNs 的 CNB。FNA 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为 65%、99%、99%、80%和 85%，CNB 分别为 87%、100%、100%、93%和 95%。172 例 CNB 患者（cN0-CNB 组）和 487 例 FNA 患者（cN0-FNA 组）行 SNB。cN0-CNB 组（Tis6、T197、T266、T33 例）和 cN0-FNA 组（Tis21、T1225、T2233、T38 例）共 172 例患者的淋巴结转移数进行了比较。cN0-CNB 组中有 9 例（5%）和 0 例（0%）患者有 3 个以上阳性 SNB 和阳性 LNs，cN0-FNA 组中有 78 例（16%）和 24 例（5%）患者有 3 个以上阳性 SNB 和阳性 LNs，cN0-CNB 组中有 1 例（0.5%）和 1 例（0.5%）患者在 CNB 和 FNA 后 7-14 天出现血肿和疼痛等并发症，cN0-FNA 组中无患者出现此类并发症。