Kim Won Hwa, Kim Hye Jung, Jung Jin Hyang, Park Ho Yong, Lee Jeeyeon, Kim Wan Wook, Park Ji Young, Cheon Hyejin, Lee So Mi, Cho Seung Hyun, Shin Kyung Min, Kim Gab Chul
Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea.
Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea.
Ultrasound Med Biol. 2017 Nov;43(11):2576-2581. doi: 10.1016/j.ultrasmedbio.2017.07.011. Epub 2017 Aug 19.
Ultrasonography-guided fine-needle aspiration (US-guided FNA) for axillary lymph nodes (ALNs) is currently used with various techniques for the initial staging of breast cancer and tagging of ALNs. With the implementation of the tattooing of biopsied ALNs, the rate of false-negative results of US-guided FNA for non-palpable and suspicious ALNs and concordance with sentinel lymph nodes were determined by node-to node analyses. A total of 61 patients with breast cancer had negative results for metastasis on US-guided FNA of their non-palpable and suspicious ALNs. The biopsied ALNs were tattooed with an injection of 1-3 mL Charcotrace (Phebra, Lane Cove West, Australia) ink and removed during sentinel lymph node biopsy or axillary dissection. We determined the rate of false-negative results and concordance with the sentinel lymph nodes by a retrospective review of surgical and pathologic findings. The association of false-negative results with clinical and imaging factors was evaluated using logistic regression. Of the 61 ALNs with negative results for US-guided FNA, 13 (21%) had metastases on final pathology. In 56 of 61 ALNs (92%), tattooed ALNs corresponded to the sentinel lymph nodes. Among the 5 patients (8%) without correspondence, 1 patient (2%) had 2 metastatic ALNs of 1 tattooed node and 1 sentinel lymph node. In multivariate analysis, atypical cells on FNA results (odds ratio = 20.7, p = 0.040) was independently associated with false-negative FNA results. False-negative ALNs after US-guided FNA occur at a rate of 21% and most of the tattooed ALNs showed concordance with sentinel lymph nodes.
超声引导下腋窝淋巴结细针穿刺活检（US引导下FNA）目前用于乳腺癌初始分期及腋窝淋巴结标记的多种技术中。随着对活检腋窝淋巴结进行纹身标记，通过逐个淋巴结分析确定了US引导下FNA对不可触及且可疑腋窝淋巴结的假阴性率以及与前哨淋巴结的一致性。共有61例乳腺癌患者不可触及且可疑腋窝淋巴结的US引导下FNA转移结果为阴性。对活检腋窝淋巴结注射1 - 3 mL夏科氏色素（Phebra，澳大利亚莱恩科夫韦斯特）墨水进行纹身标记，并在前哨淋巴结活检或腋窝清扫术中切除。我们通过回顾性分析手术和病理结果确定假阴性率以及与前哨淋巴结的一致性。使用逻辑回归评估假阴性结果与临床和影像学因素的相关性。在61个US引导下FNA结果为阴性的腋窝淋巴结中，13个（21%）最终病理显示有转移。61个腋窝淋巴结中有56个（92%），纹身标记的腋窝淋巴结与前哨淋巴结相对应。在5例（8%）不对应的患者中，1例（2%）在1个纹身标记淋巴结和1个前哨淋巴结中有2个转移腋窝淋巴结。多因素分析显示，FNA结果中出现非典型细胞（优势比 = 20.7，p = 0.040）与FNA假阴性结果独立相关。US引导下FNA后腋窝淋巴结假阴性发生率为21%，且大多数纹身标记的腋窝淋巴结与前哨淋巴结一致。
