Department of Obstetrics and Gynecology, Breast Unit, University Hospital of Heidelberg, Germany.
Institute of Pathology, University Hospital of Heidelberg, Germany.
Eur J Radiol. 2021 Feb;135:109468. doi: 10.1016/j.ejrad.2020.109468. Epub 2020 Dec 4.
Axillary ultrasound (AUS) is a standard procedure in the preoperative clinical identification of axillary metastatic lymph node (LN) involvement. It guides decisions about local and systemic therapy for patients with early breast cancer (EBC). But there is only weak evidence on the diagnostic criteria and standard interpretation. The aim of this study was to assess the performance of AUS in the detection and exclusion of LN metastases.
In a retrospective single-center study, 611 consecutive EBC patients with 622 axillae underwent AUS +/- core needle biopsy (CNB) plus axillary surgery, i.e. sentinel lymph node biopsy and/or axillary lymph node dissection. For all patients, AUS image documentation of at least the most suspicious LN was saved during the initial diagnostic work-up. The diagnostic outcome measures were sensitivity, specificity, accuracy, Youden-index (YI), and diagnostic odds ratio (DOR) on the basis of the daily routine interpretation and on the basis of previously recommended diagnostic criteria by two blinded examiners.
On the basis of the daily routine interpretation, AUS had a sensitivity (95 % CI) of 53.3 % (46.4-60.1), a specificity (95 % CI) of 93.6 % (90.8-95.8), an accuracy (95 % CI) of 79.7 % (76.4-82.8), a YI (95 % CI) of 0.47 (0.40 - 0.54), and a DOR (95 % CI) of 16.75 (10.37-27.05). Systematic application of previously recommended diagnostic criteria did not improve the diagnostic accuracy of routinely interpreted AUS.
AUS performance alone is not sufficient to accurately identify or exclude axillary metastatic disease in unselected patients with EBC.
腋窝超声（AUS）是术前临床识别腋窝转移性淋巴结（LN）的标准程序。它指导早期乳腺癌（EBC）患者的局部和全身治疗决策。但是，关于诊断标准和标准解释的证据很少。本研究旨在评估 AUS 在检测和排除 LN 转移方面的性能。
在回顾性单中心研究中，611 例连续 EBC 患者的 622 个腋窝接受了 AUS +/- 核心针活检（CNB）+腋窝手术，即前哨淋巴结活检和/或腋窝淋巴结清扫术。对于所有患者，在初始诊断性工作期间保存了至少最可疑 LN 的 AUS 图像文档。诊断结果指标是基于日常常规解释以及两名盲法检查者先前推荐的诊断标准的敏感性、特异性、准确性、Youden 指数（YI）和诊断比值比（DOR）。
基于日常常规解释，AUS 的敏感性（95 % CI）为 53.3 %（46.4-60.1），特异性（95 % CI）为 93.6 %（90.8-95.8），准确性（95 % CI）为 79.7 %（76.4-82.8），YI（95 % CI）为 0.47（0.40-0.54），DOR（95 % CI）为 16.75（10.37-27.05）。系统应用先前推荐的诊断标准并不能提高常规解释的 AUS 诊断准确性。
单独使用 AUS 不足以准确识别或排除未经选择的 EBC 患者的腋窝转移性疾病。
