Kartal Dr. Lütfi Kirdar Şehir Hastanesi, Department of General Surgery - Istanbul, Turkey.
Rev Assoc Med Bras (1992). 2023 Jan 9;69(1):37-43. doi: 10.1590/1806-9282.20220097. eCollection 2023.
The aim of this study was to determine the role of positron emission tomography/computed tomography in the decision to perform axillary surgery by comparing positron emission tomography/computed tomography findings with pathology consistency after neoadjuvant chemotherapy.
Patients who were diagnosed for T1-4, cN1/2 breast cancer receiving neoadjuvant chemotherapy in our clinic between January 2016 and February 2021 were evaluated. Clinical and radiological responses, axillary surgery, and histopathological results after neoadjuvant chemotherapy were evaluated.
Axillary involvement was not detected in positron emission tomography/computed tomography after neoadjuvant chemotherapy in 140 (60.6%) of 231 node-positive patients. In total, 88 (62.8%) of these patients underwent sentinel lymph node biopsy, and axillary lymph node dissection was performed in 29 (33%) of these patients upon detection of 1 or 2 positive lymph nodes. The other 52 (37.1%) patients underwent direct axillary lymph node dissection, and no metastatic lymph nodes were detected in 33 (63.4%) patients. No metastatic lymph node was found pathologically in a total of 92 patients without involvement in positron emission tomography/computed tomography, and the negative predictive value was calculated as 65.7%. Axillary lymph node dissection was performed in 91 (39.4%) patients with axillary involvement in positron emission tomography/computed tomography after neoadjuvant chemotherapy. Metastatic lymph nodes were found pathologically in 83 of these patients, and the positive predictive value was calculated as 91.2%.
Positron emission tomography/computed tomography was found to be useful in the evaluation of clinical response, but it was not sufficient enough to predict a complete pathological response. When planning axillary surgery, axillary lymph node dissection should not be decided only with a positive positron emission tomography/computed tomography. Other radiological images should also be evaluated, and a positive sentinel lymph node biopsy should be the determinant of axillary lymph node dissection.
本研究旨在通过比较新辅助化疗后正电子发射断层扫描/计算机断层扫描（PET/CT）结果与病理一致性，来确定 PET/CT 在决定行腋窝手术中的作用。
评估 2016 年 1 月至 2021 年 2 月期间在我院就诊的 T1-4、cN1/2 乳腺癌接受新辅助化疗的患者。评估新辅助化疗后的临床和影像学反应、腋窝手术以及新辅助化疗后的组织病理学结果。
在 231 例淋巴结阳性患者中，140 例（60.6%）患者的新辅助化疗后 PET/CT 未检测到腋窝受累。其中，88 例（62.8%）患者行前哨淋巴结活检，在发现 1 或 2 个阳性淋巴结的 29 例患者中进行了腋窝淋巴结清扫术。另外 52 例（37.1%）患者行直接腋窝淋巴结清扫术，其中 33 例（63.4%）患者未发现转移性淋巴结。在总共 92 例 PET/CT 无受累的患者中，未发现病理性转移淋巴结，阴性预测值为 65.7%。在新辅助化疗后 PET/CT 有腋窝受累的 91 例患者中，行腋窝淋巴结清扫术。在这些患者中，83 例患者的病理检查发现转移性淋巴结，阳性预测值为 91.2%。
PET/CT 对评估临床反应是有用的，但不足以预测完全病理缓解。在计划腋窝手术时，不能仅根据 PET/CT 阳性来决定行腋窝淋巴结清扫术。还应评估其他影像学图像，阳性前哨淋巴结活检应作为腋窝淋巴结清扫术的决定因素。
