Bae Min Sun, Shin Sung Ui, Song Sung Eun, Ryu Han Suk, Han Wonshik, Moon Woo Kyung
1 Department of Radiology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea.
2 Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Acta Radiol. 2018 Apr;59(4):402-408. doi: 10.1177/0284185117723039. Epub 2017 Jul 27.
Background Most patients with early-stage breast cancer have clinically negative lymph nodes (LNs). However, 15-20% of patients have axillary nodal metastasis based on the sentinel LN biopsy. Purpose To assess whether ultrasound (US) features of a primary tumor are associated with axillary LN metastasis in patients with clinical T1-T2N0 breast cancer. Material and Methods This retrospective study included 138 consecutive patients (median age = 51 years; age range = 27-78 years) who underwent breast surgery with axillary LN evaluation for clinically node-negative T1-T2 breast cancer. Three radiologists blinded to the axillary surgery results independently reviewed the US images. Tumor distance from the skin and distance from the nipple were determined based on the US report. Association between US features of a breast tumor and axillary LN metastasis was assessed using a multivariate logistic regression model after controlling for clinicopathologic variables. Results Of the 138 patients, 28 (20.3%) had nodal metastasis. At univariate analysis, tumor distance from the skin ( P = 0.019), tumor size on US ( P = 0.023), calcifications ( P = 0.036), architectural distortion ( P = 0.001), and lymphovascular invasion ( P = 0.049) were associated with axillary LN metastasis. At multivariate analysis, shorter skin-to-tumor distance (odds ratio [OR] = 4.15; 95% confidence interval [CI] = 1.01-16.19; P = 0.040) and masses with associated architectural distortion (OR = 3.80; 95% CI = 1.57-9.19; P = 0.003) were independent predictors of axillary LN metastasis. Conclusion US features of breast cancer can be promising factors associated with axillary LN metastasis in patients with clinically node-negative early-stage breast cancer.
大多数早期乳腺癌患者的临床淋巴结（LN）为阴性。然而，基于前哨淋巴结活检，15%-20%的患者存在腋窝淋巴结转移。目的：评估临床T1-T2N0期乳腺癌患者原发肿瘤的超声（US）特征是否与腋窝淋巴结转移相关。材料与方法：这项回顾性研究纳入了138例连续接受乳腺手术及腋窝淋巴结评估的临床淋巴结阴性的T1-T2期乳腺癌患者（中位年龄=51岁；年龄范围=27-78岁）。三位对腋窝手术结果不知情的放射科医生独立审查超声图像。根据超声报告确定肿瘤距皮肤的距离和距乳头的距离。在控制临床病理变量后，使用多因素逻辑回归模型评估乳腺肿瘤的超声特征与腋窝淋巴结转移之间的关联。结果：138例患者中，28例（20.3%）有淋巴结转移。单因素分析显示，肿瘤距皮肤的距离（P=0.019）、超声测量的肿瘤大小（P=0.023）、钙化（P=0.036）、结构扭曲（P=0.001）和淋巴管侵犯（P=0.049）与腋窝淋巴结转移相关。多因素分析显示，较短的皮肤至肿瘤距离（比值比[OR]=4.15；95%置信区间[CI]=1.01-16.19；P=0.040）和伴有结构扭曲的肿块（OR=3.80；95%CI=1.57-9.19；P=0.003）是腋窝淋巴结转移的独立预测因素。结论：乳腺癌的超声特征可能是临床淋巴结阴性的早期乳腺癌患者腋窝淋巴结转移的相关因素。
