An Tein, Han Boo-Kyung, Choi Ji Soo, Ko Eun Young, Ko Eun Sook, Kim Haejung, Kim Myoung Kyoung
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Quant Imaging Med Surg. 2024 Apr 3;14(4):2946-2954. doi: 10.21037/qims-23-1452. Epub 2024 Mar 20.
Despite the common use of ultrasound (US)-guided fine-needle aspiration (FNA) for axillary node (AN) in breast cancer patients, only a limited number of studies are available regarding the diagnostic performance of AN-FNA according to the suspicion level based on US findings. This study compares the outcomes of US-guided AN-FNA in breast cancer patients, differentiating between those undergoing staging and surveillance.
A cross-sectional retrospective study with retrospective analysis was conducted on 767 consecutive AN-FNA procedures performed in 2017 at Samsung Medical Center in Seoul, with 654 for staging and 113 for surveillance in breast cancer patients. The radiologists performed axillary US and the specific finding was prospectively classified into the AN-reporting and data system (AN-RADS) category 3-5 before FNA. The malignancy rate of each category was evaluated. The chi-square test, with or without Bonferroni correction, or Fisher's exact test was used to compare the malignancy rates between the staging and surveillance groups for each category.
Among the 767 AN-FNAs, 424 (55.3%) were malignant. The malignancy rate was significantly higher in the staging group (59.5%) than in the surveillance group (31.0%, P<0.0001). The distribution of AN-RADS categories differed between the groups (P=0.015), with 4A being the most common. The malignancy rates in categories 3, 4A, 4B, 4C, and 5 were as follows: 5.6%, 36.0%, 77.4%, 87.7%, and 98.4% in the staging group, and 0.0%, 9.7%, 53.3%, 88.9%, and 100% in the surveillance group. The malignancy rate was significantly different between the two groups only in category 4A (P=0.0001).
AN-FNA according to AN-RADS category appears to be an appropriate method for determination of axillary nodal status. Overall malignancy rate of AN-FNA in breast cancer patients was higher in the staging group than in the surveillance group. According to the suspicion level, the difference between two groups was significant only in category 4A.
尽管超声（US）引导下细针穿刺抽吸（FNA）在乳腺癌患者腋窝淋巴结（AN）检查中应用广泛，但基于超声检查结果的可疑程度，关于AN-FNA诊断性能的研究却为数不多。本研究比较了乳腺癌患者中接受分期检查和监测的两组患者US引导下AN-FNA的结果。
对2017年在首尔三星医疗中心连续进行的767例AN-FNA手术进行横断面回顾性研究及回顾性分析，其中654例用于乳腺癌分期，113例用于监测。放射科医生进行腋窝超声检查，并在FNA前将特定发现前瞻性地分类为腋窝淋巴结报告和数据系统（AN-RADS）3-5类。评估每类的恶性率。采用卡方检验（有或无Bonferroni校正）或Fisher精确检验比较各分类下分期组和监测组之间的恶性率。
在767例AN-FNA中，424例（55.3%）为恶性。分期组的恶性率（59.5%）显著高于监测组（31.0%，P<0.0001）。两组间AN-RADS分类分布不同（P=0.015），4A类最为常见。3、4A、4B、4C和5类的恶性率如下：分期组分别为5.6%、36.0%、77.4%、87.7%和98.4%，监测组分别为0.0%、9.7%、53.3%、88.9%和100%。两组间恶性率仅在4A类中有显著差异（P=0.0001）。
根据AN-RADS分类进行AN-FNA似乎是确定腋窝淋巴结状态合适的方法。乳腺癌患者中，分期组AN-FNA的总体恶性率高于监测组。根据可疑程度，两组间差异仅在4A类中显著。
