Singh Rashpal, Deo S V S, Dhamija Ekta, Mathur Sandeep, Thulkar Sanjay
Department of Surgical Oncology, BRA, IRCH, All India Institute Of Medical Sciences (AIIMS), New Delhi, India.
Surgical Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh India.
Indian J Surg Oncol. 2020 Dec;11(4):726-734. doi: 10.1007/s13193-020-01222-3. Epub 2020 Oct 19.
In breast cancer, axillary lymph node involvement directly impacts the patient survival and prognosis. Sentinel lymph node biopsy (SLNB) is a procedure of choice for axillary staging in early breast cancer. Currently, management options for axilla management are axillary lymph node dissection and sentinel node biopsy in node positive and in node negative respectively. Accuracy of current clinical methods for evaluating axilla is low. Hence, to select patients for appropriate procedure, ultrasound (USG) combined with fine-needle aspiration cytology (USG-FNAC) using vascular pedicle-based nodal mapping method is emerging as a good tool to address above issues. We evaluated the feasibility of ultrasound and needle aspiration cytology in a tertiary care center. All early breast cancer patients with clinically node-negative axilla and having palpable nodes with less than or equal to 5 cm tumor size in breast were screened by ultrasound of axilla to categorize the nodes as suspicious or non-suspicious based on radiological features and vascular pedicle-based nodal mapping method of axilla. Patients having suspicious nodes underwent ultrasound of axilla and needle aspiration; if found positive, patient underwent axillary node dissection. Sentinel node biopsy (SLNB) performed in all patients found negative on needle aspiration and in all patients having non-suspicious nodes on ultrasound axilla. Final histopathology was taken as gold standard. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for ultrasound (USG) and ultrasound-guided needle aspiration (USG-FNAC). A total of 100 patients were included in which 58 had non-suspicious and 42 had suspicious nodes on ultrasound of axilla. Among suspicious group, 24 were positive on ultrasound-guided needle aspiration cytology and 18 were negative. In non-suspicious nodes, sentinel node biopsy was performed. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasound were 61.5%, 75.6%, 69.5%, and 68.5% respectively. For ultrasound-guided needle aspiration (USG-FNAC), sensitivity, specificity, and positive and negative predictive value are 83%, 100%, 100%, and 72.6% respectively. The accuracy of ultrasound (USG) and ultrasound-guided needle aspiration (USG-FNAC) was 69% and 88.1%. The result of our study indicates the feasibility of USG and USG-FNAC in a high-volume center with good accuracy of around 70-80%. Approximately one-fourth (24%) of the total patients were taken up for axillary lymph node dissection (ALND) without performing SLNB.
在乳腺癌中，腋窝淋巴结受累直接影响患者的生存和预后。前哨淋巴结活检（SLNB）是早期乳腺癌腋窝分期的首选方法。目前，腋窝处理的管理方案分别是对淋巴结阳性患者进行腋窝淋巴结清扫，对淋巴结阴性患者进行前哨淋巴结活检。当前评估腋窝的临床方法准确性较低。因此，为选择合适治疗方法的患者，采用基于血管蒂的淋巴结定位方法，将超声（USG）与细针穿刺细胞学检查（USG-FNAC）相结合，正成为解决上述问题的一种良好工具。我们在一家三级医疗中心评估了超声和针吸细胞学检查的可行性。对所有临床腋窝淋巴结阴性、乳腺可触及结节且肿瘤大小小于或等于5厘米的早期乳腺癌患者进行腋窝超声检查，根据放射学特征和基于血管蒂的腋窝淋巴结定位方法将淋巴结分类为可疑或不可疑。有可疑淋巴结的患者接受腋窝超声和针吸检查；如果结果为阳性，则患者接受腋窝淋巴结清扫。对所有针吸检查为阴性的患者以及腋窝超声检查显示无可疑淋巴结的所有患者进行前哨淋巴结活检。最终组织病理学检查被视为金标准。计算超声（USG）和超声引导下针吸检查（USG-FNAC）的敏感性、特异性、准确性、阳性预测值和阴性预测值。总共纳入100例患者，其中58例腋窝超声检查无可疑淋巴结，42例有可疑淋巴结。在可疑组中，24例超声引导下针吸细胞学检查为阳性，18例为阴性。对无可疑淋巴结的患者进行前哨淋巴结活检。超声的敏感性、特异性、阳性预测值和阴性预测值分别为61.5%、75.6%、69.5%和68.5%。对于超声引导下针吸检查（USG-FNAC），敏感性、特异性、阳性和阴性预测值分别为83%、100%、100%和72.6%。超声（USG）和超声引导下针吸检查（USG-FNAC）的准确性分别为69%和88.1%。我们的研究结果表明，在大容量中心，USG和USG-FNAC具有可行性，准确性约为70%-80%。约四分之一（24%）的患者未进行SLNB就接受了腋窝淋巴结清扫（ALND）。
Int J Surg. 2017-9-7
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