Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Br J Radiol. 2021 Nov 1;94(1127):20210788. doi: 10.1259/bjr.20210788. Epub 2021 Sep 7.
To evaluate the role of axillary ultrasonography (axUS) and ultrasound-guided pre-operative wire localisation of pre-treatment positive clipped node (CN) for prediction of nodal response to neoadjuvant chemotherapy (NACT) in node positive breast carcinoma patients.
A prospective study was conducted between June 2018 and August 2020 after Ethics Committee approval. Breast carcinoma patients (cT1-cT4b) with palpable axillary nodes (cN1-cN3) and suitable for NACT were recruited after written informed consent. Single, most suspicious node was biopsied and clipped. Nodal response to NACT was assessed on axUS. Wire localisation of CN was performed prior to axillary lymph node dissection (ALND). Diagnostic performances of axUS and CN excision were assessed.
Of the 69 patients evaluated, 32 patients (mean age, 43.5 ± 11.8 years; females, 31/32 [97%]; pre-menopausal, 18/32 [56.3%]) with metastatic nodes who received NACT were included. Nodal pathological complete response rate was 34.4% (11/32) overall and 70% (7/10) in patients with ≤2 suspicious nodes on pre-NACT axUS. False-negative rates (FNRs) of axUS and CN excision were 4.8% and 28.6% respectively. Combination of post-NACT axUS and CN excision had an FNR of 4.8% overall and 0% in patients with ≤2 suspicious nodes on pre-NACT axUS.
Combination of AxUS and ultrasound-guided wire localisation of pre-treatment positive CN has high diagnostic accuracy for nodal restaging after NACT in node positive breast cancer patients.
Addition of axUS assessment to wire localisation of CN reduces its FNR for detecting residual metastasis after NACT.
评估腋窝超声（axUS）和超声引导下术前对预处理阳性夹闭淋巴结（CN）的定位在预测阳性腋窝淋巴结乳腺癌患者新辅助化疗（NACT）后淋巴结反应中的作用。
本前瞻性研究于 2018 年 6 月至 2020 年 8 月在伦理委员会批准后进行。经书面知情同意，招募了适合 NACT 的可触及腋窝淋巴结（cN1-cN3）的乳腺癌患者（cT1-cT4b）。对单个最可疑的淋巴结进行活检和夹闭。在进行腋窝淋巴结清扫（ALND）之前，对 CN 进行超声引导下的定位。评估 axUS 对 NACT 后淋巴结的反应。评估 axUS 和 CN 切除的诊断性能。
在评估的 69 例患者中，有 32 例（平均年龄，43.5±11.8 岁；女性，31/32[97%]；绝经前，18/32[56.3%]）接受 NACT 的转移性淋巴结患者被纳入研究。总体淋巴结病理完全缓解率为 34.4%（11/32），在术前 axUS 上≤2 个可疑淋巴结的患者中为 70%（7/10）。axUS 和 CN 切除的假阴性率（FNR）分别为 4.8%和 28.6%。术后 axUS 和 CN 切除联合检查的 FNR 总体为 4.8%，在术前 axUS 上≤2 个可疑淋巴结的患者中为 0%。
在阳性腋窝淋巴结乳腺癌患者中，AxUS 与术前治疗阳性 CN 的超声引导下导丝定位相结合，对 NACT 后淋巴结再分期具有较高的诊断准确性。
将 axUS 评估添加到 CN 的导丝定位中，可以降低 NACT 后检测残留转移的 FNR。
