一项超声、对比增强 MRI 与 18F-FDG PET/CT 在前哨淋巴结阴性乳腺癌患者腋窝淋巴结转移术前检测的前瞻性对比研究。

A prospective comparative study of ultrasonography, contrast-enhanced MRI and 18F-FDG PET/CT for preoperative detection of axillary lymph node metastasis in breast cancer patients.

出版信息

Ann Ital Chir. 2020;91:458-464.

Abstract

AIM

We aimed to evaluate; (i) the accuracy of ultrasonography (US), contrast-enhanced magnetic resonance imaging (cMRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detection of axillary lymph node metastases (ALNMs), (ii) the role of late prone imaging, and (iii) the effect of PET/CT on preoperative staging of breast cancer.

MATERIAL AND METHODS

From June 2015 to January 2019, 236 breast cancer patients were preoperatively exam ined using US, cMRI, and PET/CT and whom underwent pathological evaluations of axillary lymph nodes were analyzed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) of US, cMRI, and PET/CT for ALNMs were determined.

RESULTS

There were 235 female and one male in our study. The mean age was 55,6±11,3 years. Of 158 patients who were histopathologically evaluated, 85 patients (36%) were negative and 73 patients (30.9%) were positive for ALNMs. The remaining 78 patients who were only radiologically evaluated with US and/or cMRI, 24 patients (10.2%) were negative and 54 patients (22.9%) were positive for ALNMs. The sensitivity, specificity, PPV, NPV, and ACC of PET/CT were 80.0%, 92.2%, 92.0%, 80.3%, and 85.7%, re spectively. The axillary lymph node, which was suspicious in supine imaging, remained in the suspicious group again in prone imaging in PET/CT.

CONCLUSIONS

There is no single absolute modality for de tecting ALNMs in breast cancers to replace sentinel lymph node biopsy or axillary lymph node dissection. If ALNM is suspected based on PET/CT, axillary lymph node dissection without sentinel lymph node biopsy might be a better option because it is related to high possibilities of ALNM.

KEY WORDS

Axillary lymph node metastasis, Magnetic resonance imaging, Ultrasonography, 18F-FDG PET/CT.

摘要

目的

我们旨在评估：（i）超声（US）、对比增强磁共振成像（cMRI）和 18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）检测腋窝淋巴结转移（ALNM）的准确性，（ii）俯卧位成像的作用，以及（iii）PET/CT 对乳腺癌术前分期的影响。

材料和方法

2015 年 6 月至 2019 年 1 月，对 236 例乳腺癌患者进行术前 US、cMRI 和 PET/CT 检查，并对接受腋窝淋巴结病理评估的患者进行分析。确定 US、cMRI 和 PET/CT 对 ALNM 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性（ACC）。

结果

本研究共纳入 235 名女性和 1 名男性患者，平均年龄为 55.6±11.3 岁。在 158 例经组织病理学评估的患者中，85 例（36%）为阴性，73 例（30.9%）为 ALNM 阳性。其余 78 例仅接受 US 和/或 cMRI 影像学评估的患者中，24 例（10.2%）为阴性，54 例（22.9%）为 ALNM 阳性。PET/CT 的敏感性、特异性、PPV、NPV 和 ACC 分别为 80.0%、92.2%、92.0%、80.3%和 85.7%。在 PET/CT 中，仰卧位成像可疑的腋窝淋巴结在俯卧位成像中再次留在可疑组。