Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu, 41404, Republic of Korea.
Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
Cancer Imaging. 2019 Feb 1;19(1):4. doi: 10.1186/s40644-019-0191-y.
Although the role of axillary imaging has been redirected for predicting high nodal burden rather than predicting nodal metastases since ACOSOG Z1011 trial, it remains unclear whether and how axillary lymph node (ALN) characteristics predicts high nodal burden. Our study was aimed to evaluate the predictive value of imaging characteristics of ALNs at ultrasound and magnetic resonance imaging (MRI) for prediction of high nodal burden (≥3 metastatic ALNs) in clinically node-negative breast cancer patients.
Clinicopathological and imaging characteristics were evaluated in patients with ultrasound (n = 312) and MRI (n = 256). Imaging characteristics include number of suspicious ALNs and cortical morphologic changes (grade 1, cortical thickness < 2 mm; grade 2, 2-5 mm; grade 3, ≥5 mm or fatty hilum loss). Odds ratios (ORs) were calculated using multivariate analysis.
For ultrasound, higher (≥2) T stage (OR = 5.65, P = .005), higher number of suspicious ALNs (2 suspicious ALNs, OR = 6.52, P = .019; ≥ 3 suspicious ALNs, OR = 21.08, P = .005), and grade 3 of cortical morphologic changes (OR = 9.85, P = .023) independently associated with high nodal burden. For MRI, higher (≥2) T stage (OR = 5.17, P = .011) and higher number of suspicious ALNs (2 suspicious ALNs, OR = 69.00, P = .001; ≥ 3 suspicious ALNs, OR = 93.55, P < .001) were independently associated with high nodal burden. Among patients with 2 suspicious ALNs, those with grade 3 cortical morphologic change at ultrasound had a higher rate of high nodal burden than those with grade 2 (60.0% [3/5] vs. 25.0% [2/8]).
A higher number of suspicious ALNs is an independent predictor for high nodal burden. Further stratification can be achieved by incorporating assessment of ultrasound-based cortical morphologic changes.
自 ACOSOG Z1011 试验以来，腋窝影像学在预测高淋巴结负担方面的作用已从预测淋巴结转移转向预测高淋巴结负担，但目前尚不清楚腋窝淋巴结（ALN）的特征是否以及如何预测高淋巴结负担（≥3 个转移性 ALN）。本研究旨在评估超声和磁共振成像（MRI）中 ALN 的影像学特征对临床阴性乳腺癌患者高淋巴结负担（≥3 个转移性 ALN）的预测价值。
评估了 312 例超声和 256 例 MRI 患者的临床病理和影像学特征。影像学特征包括可疑 ALN 的数量和皮质形态学改变（1 级，皮质厚度<2mm；2 级，2-5mm；3 级，≥5mm 或脂肪门消失）。使用多变量分析计算比值比（OR）。
对于超声，更高（≥2）T 分期（OR=5.65，P=0.005）、更多可疑 ALN（2 个可疑 ALN，OR=6.52，P=0.019；≥3 个可疑 ALN，OR=21.08，P=0.005）和 3 级皮质形态学改变（OR=9.85，P=0.023）与高淋巴结负担独立相关。对于 MRI，更高（≥2）T 分期（OR=5.17，P=0.011）和更多可疑 ALN（2 个可疑 ALN，OR=69.00，P=0.001；≥3 个可疑 ALN，OR=93.55，P<0.001）与高淋巴结负担独立相关。在 2 个可疑 ALN 的患者中，超声皮质形态学改变 3 级的患者高淋巴结负担率高于 2 级（60.0%[3/5]比 25.0%[2/8]）。
更多可疑 ALN 是高淋巴结负担的独立预测因子。通过结合超声皮质形态学改变的评估，可以进一步进行分层。
