Department of Gynecology, Obstetrics, and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Saar, Germany.
Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, 44195, USA.
Arch Gynecol Obstet. 2024 Nov;310(5):2623-2630. doi: 10.1007/s00404-024-07699-5. Epub 2024 Sep 2.
To assess the accuracy of preoperative sonographic staging in patients with primary invasive breast cancer.
We retrospectively analyzed a prospectively kept service database of patients with newly diagnosed, unifocal, cT1-3, invasive breast cancer. All patients were diagnosed at a single center institution between January 2013 and December 2021. Clinical T stage was assessed preoperatively by ultrasound and correlated with the definite postoperative pathologic T stage. Demographics, clinical and pathological characteristics were collected. Factors influencing accuracy, over- and underdiagnosis of sonographic staging were analyzed with multivariable regression analysis.
A total of 2478 patients were included in the analysis. Median patients' age was 65 years. 1577 patients (63.6%) had clinical T1 stage, 864 (34.9%) T2 and 37 (1.5%) T3 stage. The overall accuracy of sonography and histology was 76.5% (n = 1896), overestimation was observed in 9.1% (n = 225) of all cases, while underestimation occurred in 14.4% (n = 357) of all cases. Accuracy increased when clinical tumor stage cT was higher (OR 1.23; 95% CI 1.10-1.38, p ≤ 0.001). The highest accuracy was seen for patients with T2 stage (82.8%). The accuracy was lower in Luminal B tumors compared to Luminal A tumors (OR 0.71; 95% CI 0.59-0.87, p ≤ 0.001). We could not find any association between sonographic accuracy in HER2 positive patients, and demographic characteristics, or tumor-related factors.
Our unicentric study showed a high accuracy of sonography in predicting T stage, especially for tumors with clinical T2 stage. Tumor stage and biological tumor factors do affect the accuracy of sonographic staging.
评估原发性浸润性乳腺癌患者术前超声分期的准确性。
我们回顾性分析了 2013 年 1 月至 2021 年 12 月期间在单一中心机构新诊断为单发、局限性 cT1-3 浸润性乳腺癌的患者的前瞻性保存服务数据库。所有患者均通过超声检查术前评估临床 T 分期，并与明确的术后病理 T 分期相关联。收集患者的人口统计学、临床和病理特征。采用多变量回归分析，分析影响超声分期准确性、过度诊断和低估诊断的因素。
共有 2478 例患者纳入分析。患者的中位年龄为 65 岁。1577 例（63.6%）患者为临床 T1 期，864 例（34.9%）患者为 T2 期，37 例（1.5%）患者为 T3 期。超声和组织学的总体准确性为 76.5%（n=1896），所有病例中高估 9.1%（n=225），低估 14.4%（n=357）。当临床肿瘤分期 cT 较高时，准确性增加（OR 1.23；95%CI 1.10-1.38，p≤0.001）。T2 期患者的准确性最高（82.8%）。与 Luminal A 肿瘤相比，Luminal B 肿瘤的准确性较低（OR 0.71；95%CI 0.59-0.87，p≤0.001）。我们未发现 HER2 阳性患者的超声准确性与人口统计学特征或肿瘤相关因素之间存在任何关联。
我们的单中心研究表明，超声在预测 T 分期方面具有较高的准确性，尤其是对于临床 T2 期肿瘤。肿瘤分期和生物学肿瘤因素确实会影响超声分期的准确性。
