Departments of Ultrasound, Peking University Shenzhen Hospital.
Departments of Radiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University.
Ultrasound Q. 2020 Jun;36(2):173-178. doi: 10.1097/RUQ.0000000000000495.
Since the Z0011 trial, the clinical evaluation of axillary status has been redirected to predicting nodal tumor burden rather than nodal metastases. Our study aimed to evaluate the value of clinicopathological factors and axillary ultrasound (US) for the prediction of a high nodal burden (≥3 metastatic lymph nodes) in breast cancer patients. A total of 532 consecutive patients who underwent preoperative axillary US and subsequent surgery for clinical T1-2 breast cancer with a final pathologic analysis were included. Clinical and pathologic variables were retrospectively evaluated. Univariate and multivariate statistical analyses were performed to identify the variables that were associated with a high nodal burden. Among the 532 patients, 110 (20.7%) had a high axillary nodal burden and 422 (79.3%) had a limited nodal burden. The multivariate analysis showed that suspicious axillary US findings (P < 0.001), clinical T2 stage (P = 0.011), the presence of lymphovascular invasion (P < 0.001), and estrogen receptor positivity (P < 0.001) were significantly associated with a high nodal burden. Patients with negative axillary US findings seldom had a high nodal burden, with a negative predictive value of 93.0% (294/316). Patients with suspicious axillary US findings, clinical T2 stage, lymphovascular invasion, and estrogen receptor positivity are more likely to have a high nodal burden, which may provide additional information for the treatment plan of breast cancer patients. Preoperative axillary US helps identify a limited nodal burden in breast cancer patients and has implications for axillary lymph node dissection and adjuvant treatment.
自 Z0011 试验以来，腋窝状况的临床评估已转向预测淋巴结肿瘤负担，而不是淋巴结转移。我们的研究旨在评估临床病理因素和腋窝超声（US）在预测乳腺癌患者高淋巴结负担（≥3 个转移性淋巴结）中的价值。共纳入 532 例连续接受术前腋窝超声检查且随后因临床 T1-2 期乳腺癌行手术治疗并进行最终病理分析的患者。回顾性评估临床和病理变量。进行单变量和多变量统计分析以确定与高淋巴结负担相关的变量。在 532 例患者中，110 例（20.7%）有高腋窝淋巴结负担，422 例（79.3%）有有限的淋巴结负担。多变量分析显示，可疑腋窝 US 发现（P<0.001）、临床 T2 期（P=0.011）、存在脉管侵犯（P<0.001）和雌激素受体阳性（P<0.001）与高淋巴结负担显著相关。腋窝 US 检查结果阴性的患者很少有高淋巴结负担，阴性预测值为 93.0%（294/316）。腋窝 US 检查结果可疑、临床 T2 期、脉管侵犯和雌激素受体阳性的患者更有可能存在高淋巴结负担，这可能为乳腺癌患者的治疗计划提供额外信息。术前腋窝 US 有助于识别乳腺癌患者的有限淋巴结负担，对腋窝淋巴结清扫和辅助治疗有影响。
