Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands.
Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
Eur J Surg Oncol. 2019 Apr;45(4):573-577. doi: 10.1016/j.ejso.2019.01.012. Epub 2019 Jan 14.
Imaging findings can be affected by histopathological characteristics, such as breast cancer subtypes. The aim was to determine whether the diagnostic performance, in particular negative predictive value (NPV), of axillary US differs per subtype of breast cancer.
All patients diagnosed between 2008 and 2016 in our hospital with primary invasive breast cancer and an axillary US prior to axillary surgery were included. Histopathology of axillary surgery specimens served as gold standard. The NPV, sensitivity, specificity, positive predictive value (PPV) and accuracy of the axillary US were determined for the overall population and for each subtype (ER+/PR+HER2-,HER2+, triple negative tumors). The Chi-square test was used to determine the difference in diagnostic performance parameters between the subtypes.
A total of 1094 breast cancer patients were included. Of these, 35 were diagnosed with bilateral breast cancer, resulting in 1129 cancer cases. Most common subtype was ER+/PR+HER2- in 858 cases (76.0%), followed by 150 cases of HER2+ tumors (13.3%) and 121 cases of triple negative tumors (10.7%). Sensitivity, specificity and accuracy of axillary US did not significantly differ between the subtypes. There was a significant difference for NPV between triple negative tumors and HER2+ tumors (90.3% vs. 80.2%, p = 0.05) and between HER2+ and ER/PR+HER2- tumors (80.2% vs. 87.2%, p = 0.04).
There was no significant difference in the diagnostic performance of axillary US between the subtypes, except for NPV. This was highest in triple negative subtype and lowest in HER2+ tumors. This can be explained by the difference in prevalence of axillary lymph node metastases in our cohort.
影像学表现可能受到组织病理学特征的影响，例如乳腺癌亚型。目的是确定腋窝超声的诊断性能，特别是阴性预测值（NPV），是否因乳腺癌亚型而异。
我们纳入了 2008 年至 2016 年间在我院诊断为原发性浸润性乳腺癌且在腋窝手术前进行腋窝超声检查的所有患者。腋窝手术标本的组织病理学检查结果为金标准。我们确定了总体人群和每种亚型（ER+/PR+HER2-、HER2+、三阴性肿瘤）的腋窝超声的 NPV、敏感性、特异性、阳性预测值（PPV）和准确性。我们使用卡方检验来确定亚型之间诊断性能参数的差异。
共纳入 1094 例乳腺癌患者。其中 35 例双侧乳腺癌，共计 1129 例癌例。最常见的亚型是 ER+/PR+HER2-，有 858 例（76.0%），其次是 150 例 HER2+肿瘤（13.3%）和 121 例三阴性肿瘤（10.7%）。腋窝超声的敏感性、特异性和准确性在各亚型之间无显著差异。三阴性肿瘤和 HER2+肿瘤之间的 NPV 存在显著差异（90.3%比 80.2%，p=0.05），HER2+肿瘤和 ER/PR+HER2-肿瘤之间的 NPV 也存在显著差异（80.2%比 87.2%，p=0.04）。
除了 NPV 之外，腋窝超声的诊断性能在各亚型之间没有显著差异。三阴性肿瘤的 NPV 最高，HER2+肿瘤的 NPV 最低。这可以用我们队列中腋窝淋巴结转移的发生率不同来解释。
