diFlorio Alexander Roberta M, Haider Steffen J, MacKenzie Todd, Goodrich Martha E, Weiss Julie, Onega Tracy
1 Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive , Lebanon, NH , USA.
2 Department of Radiology, New York Presbyterian Hospital/Columbia University Medical Center , New York, NY , USA.
Br J Radiol. 2018 Sep;91(1089):20170110. doi: 10.1259/bjr.20170110. Epub 2018 Jan 5.
Using screening mammography, this study investigated the association between obesity and axillary lymph node (LN) size and morphology.
We conducted a retrospective review of 188 females who underwent screening mammography at an academic medical centre. Length and width of the LN and hilum were measured in the largest, mammographically visible axillary node. The hilo-cortical ratio (HCR) was calculated as the hilar width divided by the cortical width. Measurements were performed by a board certified breast radiologist and a resident radiology physician. Inter-rater agreement was assessed with Pearson correlation coefficient. We performed multivariable regression analysis for associations of LN measurements with body mass index (BMI), breast density and age.
There was a strong association between BMI and LN dimensions, hilum dimensions and HCR (p < 0.001 for all metrics). There was no significant change in cortex width with increasing BMI (p = 0.15). Increases in LN length and width were found with increasing BMI [0.6 mm increase in length per unit BMI, 95% CI (0.4-0.8), p < 0.001 and0.3 mm increase in width per unit BMI, 95% CI(0.2-0.4), p < 0.001, respectively]. Inter-rater reliability for lymph node and hilum measurements was 0.57-0.72.
We found a highly significant association between increasing BMI and axillary LN dimensions independent of age and breast density with strong interobserver agreement. The increase in LN size was driven by expansion of the LN hilum secondary to fat infiltration. Advances in knowledge: This preliminary work determined a relationship between fat infiltrated axillary lymph nodes and obesity.
本研究采用乳腺钼靶筛查，调查肥胖与腋窝淋巴结（LN）大小及形态之间的关联。
我们对在一家学术医疗中心接受乳腺钼靶筛查的188名女性进行了回顾性研究。在乳腺钼靶可见的最大腋窝淋巴结中测量淋巴结及门部的长度和宽度。计算门-皮质比（HCR），即门部宽度除以皮质宽度。测量由一名获得委员会认证的乳腺放射科医生和一名放射科住院医师进行。通过Pearson相关系数评估评分者间的一致性。我们对淋巴结测量值与体重指数（BMI）、乳腺密度和年龄之间的关联进行了多变量回归分析。
BMI与淋巴结尺寸、门部尺寸和HCR之间存在强关联（所有指标p<0.001）。随着BMI增加，皮质宽度无显著变化（p=0.15）。随着BMI增加，淋巴结长度和宽度增加[每单位BMI长度增加0.6mm，95%CI（0.4-0.8），p<0.001；每单位BMI宽度增加0.3mm，95%CI（0.2-0.4），p<0.001]。淋巴结和门部测量的评分者间可靠性为0.57-0.72。
我们发现BMI增加与腋窝淋巴结尺寸之间存在高度显著的关联，独立于年龄和乳腺密度，且观察者间一致性较强。淋巴结大小的增加是由脂肪浸润导致的淋巴结门部扩张所致。知识进展：这项初步工作确定了脂肪浸润的腋窝淋巴结与肥胖之间的关系。
