From the Department of Radiology, Inha University School of Medicine, Incheon, Republic of Korea (G.R.K.); and Departments of Radiology (J.S.C., B.K.H., E.Y.K., E.S.K.) and Surgery (J.E.L., S.J.N., S.K.L.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seou 137-710, Republic of Korea.
Radiology. 2018 Jul;288(1):55-63. doi: 10.1148/radiol.2018171987. Epub 2018 Mar 20.
Purpose To evaluate the value of preoperative axillary ultrasonography (US) for preventing unnecessary axillary lymph node dissection after sentinel lymph node (SLN) biopsy in a large series of patients with early-stage breast cancers treated with both breast-conserving surgery and SLN biopsy. Materials and Methods From March 2009 to February 2013, 1802 patients who underwent breast-conserving surgery for clinical T1-2/N0 cancers and SLN biopsy with or without axillary lymph node dissection were included. Preoperative axillary US results and clinical-pathologic variables were compared according to the status of non-SLN metastasis. Multivariate logistic regression analysis was performed to find factors associated with non-SLN metastasis. Results Of 1802 patients, 397 (22.0%) underwent axillary lymph node dissection due to positive SLN biopsy and 76 (4.2%) had non-SLN metastasis at final histopathologic examination. Patients with non-SLN metastasis were younger and showed positive axilla at US and clinical T2 stage more frequently (P < .05). At multivariate analysis, positive axilla at US (P = .001), clinical T2 stage (P = .005), and lymphovascular invasion (P < .001) were significantly associated with non-SLN metastasis. Among 1284 patients with negative axilla at US and clinical T1 stage cancer, 1254 (97.7%) did not have non-SLN metastasis and 30 (2.3%) had non-SLN metastasis. Conclusion Preoperative axillary US results and clinical T stage are associated with the status of non-SLN metastasis in patients with early breast cancer. The results of this study suggest that preoperative axillary US can help select patients at minimal risk of non-SLN metastasis, for whom axillary lymph node dissection can be omitted. RSNA, 2018 Online supplemental material is available for this article.
目的 在接受保乳手术和前哨淋巴结活检（SLN）的早期乳腺癌患者中，评估术前腋窝超声（US）在预防 SLN 活检后不必要的腋窝淋巴结清扫（ALND）中的价值。
材料与方法 2009 年 3 月至 2013 年 2 月，共纳入 1802 例接受保乳手术治疗的临床 T1-2/N0 期癌症且行 SLN 活检加或不加腋窝淋巴结清扫的患者。根据非 SLN 转移情况比较术前腋窝 US 结果和临床病理变量。采用多因素逻辑回归分析寻找与非 SLN 转移相关的因素。
结果 1802 例患者中，397 例（22.0%）因 SLN 活检阳性而行 ALND，76 例（4.2%）最终病理检查发现非 SLN 转移。非 SLN 转移患者年龄较小，US 阳性和临床 T2 期更为常见（P <.05）。多因素分析显示，US 阳性（P =.001）、临床 T2 期（P =.005）和脉管侵犯（P <.001）与非 SLN 转移显著相关。在 1284 例 US 阴性和临床 T1 期癌症患者中，1254 例（97.7%）无非 SLN 转移，30 例（2.3%）有非 SLN 转移。
结论 术前腋窝 US 结果和临床 T 分期与早期乳腺癌患者非 SLN 转移的状态相关。该研究结果提示，术前腋窝 US 有助于选择非 SLN 转移风险最小的患者，可省略腋窝淋巴结清扫。
