Department of Gynaecology and Obstetrics, Saarland University Hospital, Homburg, Saar, Germany.
Department of Gynaecology and Obstetrics, Knappschaftsklinikum Puettlingen, Puettlingen, Germany.
Ann Surg Oncol. 2022 Aug;29(8):4764-4772. doi: 10.1245/s10434-022-11829-1. Epub 2022 Apr 29.
To assess the accuracy of preoperative sonographic staging for prediction of limited axillary disease (LAD, one or two metastatic lymph nodes) and to identify factors associated with high prediction-pathology concordance in patients with early-stage breast cancer meeting the Z0011 criteria.
Patients treated between January 2015 and January 2020 were included in this retrospective, multicentric analysis of prospectively acquired service databases. The accuracy of LAD prediction was assessed separately for patients with one and two suspicious lymph nodes on preoperative sonography. Test validity outcomes for LAD prediction were calculated for both groups, and a multivariate model was used to identify factors associated with high accuracy of LAD prediction.
Of 2059 enrolled patients, 1513 underwent sentinel node biopsy, 436 primary and 110 secondary axillary dissection. For LAD prediction in patients with one suspicious lymph node on preoperative ultrasound, sensitivity was 92% (95% CI 87-95%), negative predictive value (NPV) was 92% (95% CI 87-95%), and the false-negative rate (FNR) was 8% (95% CI 5-13%). For patients with two preoperatively suspicious nodes, the sensitivity, NPV, and FNR were 89% (95% CI 84-93%), 73% (62-83%), and 11% (95% CI 7-16%), respectively. On multivariate analysis, the number of suspicious lymph nodes was associated inversely with correct LAD prediction ([OR 0.01 (95% CI 0.01-0.93), p ≤ 0.01].
Sonographic axillary staging in patients with one metastatic lymph node predicted by preoperative ultrasound showed high accuracy and a false-negative rate comparable to sentinel node biopsy for prediction of limited axillary disease.
评估术前超声对预测局限性腋窝疾病（LAD，一个或两个转移性淋巴结）的准确性，并确定符合 Z0011 标准的早期乳腺癌患者中与高预测病理一致性相关的因素。
本回顾性多中心分析纳入了 2015 年 1 月至 2020 年 1 月期间治疗的患者，这些患者来自前瞻性获取服务数据库。分别评估了术前超声检查发现一个和两个可疑淋巴结的患者中 LAD 预测的准确性。为两组患者计算了 LAD 预测的试验有效性结果，并使用多变量模型确定了与 LAD 预测准确性高相关的因素。
在 2059 名入组患者中，1513 名患者接受了前哨淋巴结活检，436 名患者进行了原发和 110 名患者进行了继发腋窝清扫术。对于术前超声检查发现一个可疑淋巴结的患者，LAD 预测的敏感性为 92%（95%CI 87-95%），阴性预测值（NPV）为 92%（95%CI 87-95%），假阴性率（FNR）为 8%（95%CI 5-13%）。对于术前超声检查发现两个可疑淋巴结的患者，敏感性、NPV 和 FNR 分别为 89%（95%CI 84-93%）、73%（62-83%）和 11%（95%CI 7-16%）。多变量分析显示，可疑淋巴结数量与正确的 LAD 预测呈负相关[比值比 0.01（95%CI 0.01-0.93），p≤0.01]。
术前超声检查预测一个转移性淋巴结的腋窝超声分期显示出较高的准确性和与前哨淋巴结活检相当的假阴性率，可用于预测局限性腋窝疾病。
