阴性腋窝超声后乳腺 MRI 及列线图对 T1-2N0 期乳腺癌患者腋窝淋巴结转移的预测价值。

Value of Breast MRI and Nomogram After Negative Axillary Ultrasound for Predicting Axillary Lymph Node Metastasis in Patients With Clinically T1-2 N0 Breast Cancer.

机构信息

Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

出版信息

J Korean Med Sci. 2023 Aug 28;38(34):e251. doi: 10.3346/jkms.2023.38.e251.

DOI:10.3346/jkms.2023.38.e251

PMID:37644678

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10462481/

Abstract

BACKGROUND

There are increasing concerns about that sentinel lymph node biopsy (SLNB) could be omitted in patients with clinically T1-2 N0 breast cancers who has negative axillary ultrasound (AUS). This study aims to assess the false negative result (FNR) of AUS, the rate of high nodal burden (HNB) in clinically T1-2 N0 breast cancer patients, and the diagnostic performance of breast magnetic resonance imaging (MRI) and nomogram.

METHODS

We identified 948 consecutive patients with clinically T1-2 N0 cancers who had negative AUS, subsequent MRI, and breast conserving therapy between 2013 and 2020 from two tertiary medical centers. Patients from two centers were assigned to development and validation sets, respectively. Among 948 patients, 402 (mean age ± standard deviation, 57.61 ± 11.58) were within development cohort and 546 (54.43 ± 10.02) within validation cohort. Using logistic regression analyses, clinical-imaging factors associated with lymph node (LN) metastasis were analyzed in the development set from which nomogram was created. The performance of MRI and nomogram was assessed. HNB was defined as ≥ 3 positive LNs.

RESULTS

The FNR of AUS was 20.1% (81 of 402) and 19.2% (105 of 546) and the rates of HNB were 1.2% (5/402) and 2.2% (12/546), respectively. Clinical and imaging features associated with LN metastasis were progesterone receptor positivity, outer tumor location on mammography, breast imaging reporting and data system category 5 assessment of cancer on ultrasound, and positive axilla on MRI. In validation cohorts, the positive predictive value (PPV) and negative predictive value (NPV) of MRI and clinical-imaging nomogram was 58.5% and 86.5%, and 56.0% and 82.0%, respectively.

CONCLUSION

The FNR of AUS was approximately 20% but the rate of HNB was low. The diagnostic performance of MRI was not satisfactory with low PPV but MRI had merit in reaffirming negative AUS with high NPV. Patients who had low probability scores from our clinical-imaging nomogram might be possible candidates for the omission of SLNB.

摘要

背景

越来越多的人担心对于临床 T1-2N0 期、腋窝超声阴性的乳腺癌患者，可以省略前哨淋巴结活检（SLNB）。本研究旨在评估腋窝超声的假阴性率（FNR）、临床 T1-2N0 期乳腺癌患者的高淋巴结负荷（HNB）率，以及乳腺磁共振成像（MRI）和列线图的诊断性能。

方法

我们从两个三级医疗中心确定了 948 例连续的临床 T1-2N0 期癌症患者，这些患者在 2013 年至 2020 年期间接受了阴性腋窝超声、随后的 MRI 和保乳治疗。两个中心的患者分别被分配到开发和验证队列中。在 948 例患者中，402 例（平均年龄±标准差，57.61±11.58）在开发队列中，546 例（54.43±10.02）在验证队列中。使用逻辑回归分析，在开发队列中分析与淋巴结（LN）转移相关的临床影像学因素，并创建了列线图。评估了 MRI 和列线图的性能。HNB 定义为≥3 个阳性 LN。

结果

腋窝超声的 FNR 为 20.1%（402 例中的 81 例）和 19.2%（546 例中的 105 例），HNB 的发生率分别为 1.2%（402 例中的 5 例）和 2.2%（546 例中的 12 例）。与 LN 转移相关的临床和影像学特征是孕激素受体阳性、乳腺 X 线摄影中外侧肿瘤位置、超声评估的乳腺影像报告和数据系统（BI-RADS）类别 5、MRI 阳性腋窝。在验证队列中，MRI 和临床影像学列线图的阳性预测值（PPV）和阴性预测值（NPV）分别为 58.5%和 86.5%，56.0%和 82.0%。