Department of Surgery, Mayo Clinic Florida, Jacksonville, FL.
Department of Health Sciences Research and Biostatistics, Mayo Clinic Florida, Jacksonville, FL.
J Am Coll Surg. 2019 May;228(5):792-797. doi: 10.1016/j.jamcollsurg.2019.01.022. Epub 2019 Feb 21.
It is assumed that axillary ultrasound (AxUS) is the best method for axillary nodal evaluation in newly diagnosed breast cancer patients. However, few have evaluated the efficacy of preoperative axillary MRI. We compared the statistical accuracy of AxUS and MRI in detecting nodal metastases among breast cancer patients who were selected for neoadjuvant chemotherapy.
We retrospectively analyzed 219 breast cancer patients undergoing neoadjuvant chemotherapy from 2007 to 2015, all of whom had AxUS and breast MRI before chemotherapy. Two breast radiologists, blinded to clinical, pathologic, and AxUS findings, re-reviewed all breast MRIs, specifically focusing on axillary nodal characteristics. We correlated clinico-pathologic characteristics, AxUS, and MRI findings, and quantified predictive values of both imaging modalities.
Overall, 101 of 219 (47%) patients had T2 tumors. The most common abnormal nodal finding was size >10 mm. Axillary ultrasound and MRI agreed on nodal status in 192 of 219 patients (87.6%). When correlated with pre-chemotherapy needle biopsy in 129 patients, AxUS and axillary MRI performed similarly (sensitivity of 99.1% vs 97.4% and specificity 15.4% vs 15.4%, respectively). Only 4 of 129 (3.1%) patients had a negative MRI and positive AxUS; 3 of 4 of these patients (75%) had a positive biopsy and 2 of 3 had positive lymph nodes on final pathology, therefore suggesting MRI missed clinically significant disease in only 2 of 129 (1.5%) patients.
In a high-risk patient population, AxUS and MRI have similar statistical profiles in evaluating axillary nodal status. Routine use of AxUS after a normal axillary MRI is not warranted.
人们认为腋窝超声（AxUS）是新诊断乳腺癌患者腋窝淋巴结评估的最佳方法。然而，很少有人评估术前腋窝 MRI 的疗效。我们比较了 AxUS 和 MRI 在检测接受新辅助化疗的乳腺癌患者腋窝淋巴结转移中的统计准确性。
我们回顾性分析了 2007 年至 2015 年间接受新辅助化疗的 219 例乳腺癌患者，所有患者在化疗前均进行了 AxUS 和乳腺 MRI 检查。两位乳腺放射科医生对所有乳腺 MRI 进行了盲法重新评估，重点关注腋窝淋巴结特征。我们将临床病理特征、AxUS 和 MRI 结果进行了相关性分析，并量化了两种成像方式的预测值。
总的来说，219 例患者中 101 例（47%）为 T2 肿瘤。最常见的异常淋巴结表现为大小>10mm。AxUS 和 MRI 在 219 例患者中的 192 例（87.6%）中对淋巴结状态的判断一致。在 129 例患者中与化疗前的针吸活检结果进行比较时，AxUS 和腋窝 MRI 的表现相似（敏感性分别为 99.1%和 97.4%，特异性分别为 15.4%和 15.4%）。只有 4 例（3.1%）患者 MRI 为阴性而 AxUS 为阳性；4 例中有 3 例（75%）的活检阳性，其中 2 例（67%）的最终病理淋巴结阳性，因此仅 2 例（1.5%）患者的 MRI 漏诊了临床显著疾病。
在高危患者人群中，AxUS 和 MRI 在评估腋窝淋巴结状态方面具有相似的统计特征。在正常腋窝 MRI 后常规使用 AxUS 是没有必要的。
