Hu Yue, Mei Jingsi, Yang Yaping, Gu Ran, Zhong Jiajie, Jiang Xiaofang, Liu Fengtao, Yong Juanjuan, Wang Hongli, Shen Shiyu, Liang Jing, Liu Qiang, Gong Chang
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Quant Imaging Med Surg. 2021 May;11(5):2151-2161. doi: 10.21037/qims-20-1030.
Ultrasound (US)-guided core needle biopsy (CNB) is widely applied in the pathological diagnosis of suspicious axillary lymph nodes (ALNs) in breast cancer. However, the number of specimens removed during biopsy is currently based on the preference of the individual radiologist. This study aims to analyze the specimen number based diagnostic yields of US guided CNB of suspicious ALNs in breast cancer.
Core biopsy specimens of suspicious lymph nodes were prospectively obtained from breast cancer patients treated at our hospital between November, 2018, and July, 2019. Four specimens were obtained from each patient and labeled 1-4 in the order they were removed. Each specimen underwent pathological evaluation to determine whether metastasis had occurred. The diagnostic yields of the specimens were calculated and differences in diagnostic accuracy according to the number of specimens were evaluated by McNemar's test.
A total of 167 patients were enrolled, and 139 (83.2%) cases were identified as metastasis by CNB. The diagnostic yields were: 74.2% (specimen 1), 87.8% (specimens 1-2), 91.2% (specimens 1-3), and 94.6% (specimens 1-4). The increases in diagnostic yield from specimen 1 to 1-2 and from specimens 1-2 to 1-4 were significant; however, no significant differences were detected between specimens 1-3 and the first two, or between specimens 1-4 and the first three in this sample size. The lower diagnostic abilities for the first two specimens were associated with shorter long- and short-axis lengths of lymph nodes on US.
Although the second specimen contributed significant diagnostic yield of suspicious axillary lymph nodes in core biopsy in breast cancer, a minimum number cannot be determined by this study. Additional specimens may improve diagnostic yield particularly in patients with small nodes.
超声（US）引导下的粗针穿刺活检（CNB）广泛应用于乳腺癌可疑腋窝淋巴结（ALN）的病理诊断。然而，目前活检时获取的标本数量基于个体放射科医生的偏好。本研究旨在分析基于标本数量的乳腺癌可疑ALN的US引导下CNB的诊断率。
前瞻性地获取2018年11月至2019年7月在我院接受治疗的乳腺癌患者可疑淋巴结的粗针穿刺活检标本。从每位患者获取4个标本，并按照取出顺序标记为1-4。每个标本进行病理评估以确定是否发生转移。计算标本的诊断率，并通过McNemar检验评估根据标本数量的诊断准确性差异。
共纳入167例患者，139例（83.2%）经CNB确诊为转移。诊断率分别为：74.2%（标本1），87.8%（标本1-2），91.2%（标本1-3）和94.6%（标本1-4）。从标本1到1- 2以及从标本1-2到1-4的诊断率增加具有显著性；然而，在该样本量中，标本1-3与前两个标本之间，以及标本1-4与前三个标本之间未检测到显著差异。前两个标本较低的诊断能力与US上淋巴结较短的长轴和短轴长度相关。
尽管第二个标本对乳腺癌粗针穿刺活检中可疑腋窝淋巴结的诊断率有显著贡献，但本研究无法确定最小标本数量。额外的标本可能提高诊断率，特别是在淋巴结较小的患者中。
