Nielsen Moody Anne, Cox Karina, Haigh Isobel, Chen Yan, Sharma Nisha
Breast Radiology, Breast Imaging Department, St James's University Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK.
Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Maidstone, Kent, UK.
Eur J Radiol. 2020 Nov;132:109311. doi: 10.1016/j.ejrad.2020.109311. Epub 2020 Sep 28.
Contrast enhanced ultrasound (CEUS) of the axilla allows preoperative identification and biopsy of the sentinel lymph node. Our aims were to evaluate the accuracy of the CEUS procedure for identifying axillary lymph node metastases preoperatively and compare the volume of axillary metastases in patients with malignant versus benign CEUS guided core biopsy at end of primary surgical treatment.
Retrospective analysis of prospectively collected data on patients with breast cancer with normal axillary ultrasound or benign axillary FNAC undergoing preoperatively CEUS guided sentinel lymph node biopsy between 2013 and 2018.
SLN was successfully identified by CEUS in 186 (90.7%) of patients with definitive diagnosis obtained in 163 (87.6%). Overall sensitivity was 55.77%, but significantly higher for high volume disease (77.78%) than for low volume disease (32.00%, odds ratio = 7.44, 95% CI = 2.16 to 25.62, p = .001) Specificity was 100%. NPV was 82.84% overall, 86.72% for low volume disease and 94.87 % for high volume disease. 72.4% of patients with initial malignant CEUS guided SLN core biopsy had two or more macrometastases at end of surgical treatment compared to 4.47% of patients with initial benign CEUS guided core biopsy.
When disease was present, CEUS guided sentinel lymph node core biopsy identify nodal metastases in 55.77% of patients with normal axillary grey scale ultrasound. This study suggests that the likelihood of extensive axillary disease at end of surgical treatment is low with an initial benign CEUS guided SLN core biopsy.
腋窝超声造影（CEUS）可在术前识别前哨淋巴结并进行活检。我们的目的是评估CEUS程序术前识别腋窝淋巴结转移的准确性，并比较原发性手术治疗结束时，CEUS引导下恶性与良性粗针活检患者的腋窝转移灶体积。
回顾性分析2013年至2018年间，对腋窝超声正常或腋窝细针穿刺活检（FNAC）为良性的乳腺癌患者进行术前CEUS引导下前哨淋巴结活检的前瞻性收集数据。
186例（90.7%）患者通过CEUS成功识别前哨淋巴结，163例（87.6%）获得明确诊断。总体敏感性为55.77%，但高负荷疾病（77.78%）显著高于低负荷疾病（32.00%，优势比=7.44，95%置信区间=2.16至25.62，p=0.001）。特异性为100%。阴性预测值总体为82.84%，低负荷疾病为86.72%，高负荷疾病为94.87%。初始CEUS引导下前哨淋巴结粗针活检为恶性的患者中，72.4%在手术治疗结束时有两个或更多大转移灶，而初始CEUS引导下粗针活检为良性的患者中这一比例为约4.47%。
当存在疾病时，CEUS引导下前哨淋巴结粗针活检可在55.77%腋窝灰阶超声正常的患者中识别淋巴结转移。本研究表明，初始CEUS引导下前哨淋巴结粗针活检为良性时，手术治疗结束时出现广泛腋窝疾病的可能性较低。
