Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands.
Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532, SZ, Nijmegen, the Netherlands.
Breast. 2023 Dec;72:103593. doi: 10.1016/j.breast.2023.103593. Epub 2023 Oct 21.
The aim of the current study was to investigate time-trends in pre-operative diagnosis and surgical treatment of axillary lymph node metastases in breast cancers detected at screening mammography.
We included all women who underwent screening mammography in the South of the Netherlands between 2005 and 2020. During a follow-up period of at least two years, data on clinical radiological examinations, biopsy procedures and surgical interventions were obtained. The 15 years of inclusion were divided into five cohorts of three years each.
Of the 4049 women with invasive breast cancer, 22.1 % (896/4049) had axillary lymph node metastasis at pathology (ALN+). Percutaneous axillary biopsy was performed in 39.6 % (355/896) of these women, with the proportions of fine needle aspiration biopsy (FNAB) decreasing from 97.6 % (40/41) in 2005-2007 to 41.6 % (37/89) in 2017-2019 and core needle biopsy (CNB) rising from 2.4 % (1/41) in 2005-2007 to 58.4 % (52/89) in 2017-2019 (P < 0.001). Sensitivity of FNAB and CNB was comparable (77.4 % (188/243, 95%CI = 71%-82 %) versus 82.4 % (103/125), 95%CI = 74%-88 %) (P = 0.26). Pre-operative confirmation of ALN + by percutaneous biopsy ranged from 27.3 % (56/205) in 2011-2013 to 39.0 % (80/205) in 2017-2019, with no significant trend changes over time (P = 0.103). The proportion of ALN + women who underwent axillary lymph node dissection (ALND) decreased from 96.0 % (97/101) in 2005-2007 to 16.6 % (34/205) in 2017-2019 (P < 0.001).
Pre-operative confirmation of axillary lymph node metastasis by ultrasound-guided biopsy did not rise despite the increased use of CNB at the expense of less invasive FNAB. A significant reduction in ALND was observed through the years.
本研究旨在探讨在乳腺筛查钼靶片中发现的乳腺癌患者腋窝淋巴结转移的术前诊断和手术治疗的时间趋势。
我们纳入了 2005 年至 2020 年期间在荷兰南部接受乳腺筛查的所有女性。在至少两年的随访期间，我们获取了临床放射学检查、活检程序和手术干预的数据。15 年的纳入期分为三个三年期的五个队列。
在 4049 例浸润性乳腺癌女性中，22.1%（896/4049）在病理上有腋窝淋巴结转移（ALN+）。在这些女性中，有 39.6%（355/896）进行了经皮腋窝活检，其中细针抽吸活检（FNAB）的比例从 2005-2007 年的 97.6%（40/41）降至 2017-2019 年的 41.6%（37/89），而核心针活检（CNB）从 2005-2007 年的 2.4%（1/41）上升至 2017-2019 年的 58.4%（52/89）（P<0.001）。FNAB 和 CNB 的敏感性相当（77.4%（188/243，95%CI=71%-82%）与 82.4%（103/125），95%CI=74%-88%）（P=0.26）。经皮活检术前确认 ALN+的比例从 2011-2013 年的 27.3%（56/205）上升至 2017-2019 年的 39.0%（80/205），但时间趋势变化无统计学意义（P=0.103）。接受腋窝淋巴结清扫术（ALND）的 ALN+女性比例从 2005-2007 年的 96.0%（97/101）降至 2017-2019 年的 16.6%（34/205）（P<0.001）。
尽管 CNB 的使用增加而侵袭性更小的 FNAB 减少，但经超声引导活检术前确认腋窝淋巴结转移的比例并未上升。ALND 的比例多年来显著下降。
