Rogers Christine, Zeien Sarah, Puccetti Kaleen, Jorns Julie M, Kong Amanda L, Cherian Solomon, Cortina Chandler S
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Breast Imaging, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
Am J Surg. 2025 Jan;239:116047. doi: 10.1016/j.amjsurg.2024.116047. Epub 2024 Oct 24.
Axillary assessment in breast cancer is key to determining an upfront surgery or neoadjuvant chemotherapy (NAC) approach. We investigated the false-negative rate (FNR) of axillary-node ultrasound-guided core-needle biopsy (US-CNBx) and the surgical management of pN + patients.
This single-institution study from 2010 to 2020 included patients with benign findings on US-CNBx and upfront surgery. Statistical analyses were performed via t-tests and chi-squared tests.
95 axillae met inclusion, 23 were pN+, resulting in a US-CNBx FNR of 24.2 %. pN + patients more frequently had cT2-T3 tumors vs pN0 patients (43.5 % vs 27.8 %, p = 0.03). Of the 23 pN + patients, 9 underwent breast-conserving surgery (BCS) and 14 underwent mastectomy. In those with BCS, 7 had 1-2 positive nodes, 2 had ≥3 nodes; 3 received an ALND. In those with mastectomies, 12 had 1-2 positive nodes, 2 had ≥3 positive nodes; 6 received an ALND.
In this cohort, US-CNBx had a FNR of 24.2 %. pN + patients had a greater frequency of cT2-cT3 tumors, therefore clinicians should be cognizant of potential occult nodal disease despite negative CNBx when deciding management.
乳腺癌的腋窝评估是确定初始手术或新辅助化疗（NAC）方案的关键。我们研究了腋窝淋巴结超声引导下粗针穿刺活检（US-CNBx）的假阴性率（FNR）以及pN+患者的手术治疗。
这项来自2010年至2020年的单机构研究纳入了US-CNBx检查结果为良性且接受初始手术的患者。通过t检验和卡方检验进行统计分析。
95个腋窝符合纳入标准，23个为pN+，导致US-CNBx的FNR为24.2%。与pN0患者相比，pN+患者的cT2-T3肿瘤更为常见（43.5%对27.8%，p = 0.03）。在23例pN+患者中，9例行保乳手术（BCS），14例行乳房切除术。在接受BCS的患者中，7例有1-2个阳性淋巴结，2例有≥3个淋巴结；3例接受了腋窝淋巴结清扫术（ALND）。在接受乳房切除术的患者中，12例有1-2个阳性淋巴结，2例有≥3个阳性淋巴结；6例接受了ALND。
在该队列中，US-CNBx的FNR为24.2%。pN+患者的cT2-cT3肿瘤发生率更高，因此临床医生在决定治疗方案时，尽管CNBx结果为阴性，仍应意识到潜在的隐匿性淋巴结疾病。
