Turan Umit, Aygun Murat, Duman Berna Bozkurt, Kelle Aygül Polat, Cavus Yeliz, Tas Zeynel Abidin, Dirim Ahmet Baris, Irkorucu Oktay
Adana City Research and Training Center, Department of General Surgery, Saglik Bilimleri University, Adana 01230, Turkey.
Adana City Research and Training Center, Department of Medical Oncology, Saglik Bilimleri University, Adana 01230, Turkey.
Diagnostics (Basel). 2021 Dec 14;11(12):2361. doi: 10.3390/diagnostics11122361.
The aim of this study was to investigate the efficacy of post-neoadjuvant chemotherapy (NAC) ultrasound (US), magnetic resonance imaging (MRI), and F-18fluorodeoxyglucose positron emission tomography (F-18 FDG-PET/CT) for detecting post-NAC axillary lymph node(ALN) metastasis in patients who had ALN metastasis at the time of diagnosis.
This study included all breast cancer patients who received NAC for ALN metastasis; underwent axillary assessment with US, MRI, or F18FDG-PET/CT; and then were operated on in the General Surgery Clinic, Adana City Research and Training Hospital, Turkey. Patients' data were recorded, including demographic data, clinicopathological parameters, NAC regimens, and operation types. The axillary response to chemotherapy on post-NAC US, MRI, and F-18 FDG-PET/CT was compared with the postoperative histopathological result of the ALN.
The study included a total of 171 female patients. The mean age of the patients was 53.28 ± 10.62 years. The post-NAC assessment revealed that the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US for detecting ALN metastasis were 59.42%, 82.35%, 82.00%, and 60.00%, respectively, while the same measures regarding MRI for detecting ALN metastasis were 36.67%, 77.78%, 73.33%, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of F-18FDG-PET/CT were 47.50%, 76.67%, 73.08%, and 52.27%, respectively. The evaluation of dual combinations of these three imaging techniques showed that the specificity and PPV of the combined use of US and F-18FDG-PET/CT was 100%.
The results showed that US has the highest sensitivity and specificity for detecting ALN metastasis after NAC. Furthermore, ALND may be preferred for these patients instead of SLNB if both examinations simultaneously indicate lymph node metastasis in the post-NAC assessment with US and F-18 FDG-PET/CT. SLNB may be preferred if these two examinations simultaneously show a complete response.
本研究旨在探讨新辅助化疗（NAC）后超声（US）、磁共振成像（MRI）和F-18氟脱氧葡萄糖正电子发射断层扫描（F-18 FDG-PET/CT）对诊断时存在腋窝淋巴结（ALN）转移的患者检测NAC后ALN转移的疗效。
本研究纳入所有因ALN转移接受NAC治疗、接受US、MRI或F-18 FDG-PET/CT腋窝评估、然后在土耳其阿达纳市研究与培训医院普通外科门诊接受手术的乳腺癌患者。记录患者数据，包括人口统计学数据、临床病理参数、NAC方案和手术类型。将NAC后US、MRI和F-18 FDG-PET/CT对化疗的腋窝反应与ALN的术后组织病理学结果进行比较。
本研究共纳入171例女性患者。患者的平均年龄为53.28±10.62岁。NAC后评估显示，US检测ALN转移的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为59.42%、82.35%、82.00%和60.00%，而MRI检测ALN转移的相同指标分别为36.67%、77.78%、73.33%和42.42%。F-18 FDG-PET/CT的敏感性、特异性、PPV和NPV分别为47.50%、76.67%、73.08%和52.27%。对这三种成像技术的双重组合评估显示，US和F-18 FDG-PET/CT联合使用的特异性和PPV为100%。
结果表明，US对检测NAC后ALN转移具有最高的敏感性和特异性。此外，如果在NAC后US和F-18 FDG-PET/CT评估中这两项检查同时显示淋巴结转移，对于这些患者，可能更倾向于行腋窝淋巴结清扫术（ALND）而非前哨淋巴结活检（SLNB）。如果这两项检查同时显示完全缓解，则可能更倾向于行SLNB。
