Herrada J, Iyer R B, Atkinson E N, Sneige N, Buzdar A U, Hortobagyi G N
Departments of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Clin Cancer Res. 1997 Sep;3(9):1565-9.
The purpose of this study was to correlate physical examination and sonographic and mammographic measurements of breast tumors and regional lymph nodes with pathological findings and to evaluate the effect of neoadjuvant chemotherapy on clinical Tumor-Node-Metastasis stage by noninvasive methods. This was a retrospective analysis of 100 patients with locally advanced breast cancer registered and treated in prospective trials of neoadjuvant chemotherapy. All patients received four cycles of a doxorubicin-containing regimen and had noninvasive evaluation of the primary tumor and regional lymph nodes before and after neoadjuvant chemotherapy by physical examination, sonography, and mammography and underwent breast surgery and axillary dissection within 5 weeks after completion of neoadjuvant chemotherapy. The correlations between clinical and pathological measurements were determined by Spearman rank correlation analysis. A proportional odds model was used to examine predictive values. Eighty-three patients had both a clinically detectable primary tumor and lymph node metastases. Sixty-four patients had a decrease in Tumor-Node-Metastasis stage after chemotherapy. For 54% of patients, there was concordance in clinical response between the primary tumor and lymph node compartment; for the rest, results were discordant. Physical examination correlated best with pathological findings in the measurement of the primary tumor (P = 0.0003), whereas sonography was the most accurate predictor of size for axillary lymph nodes (P = 0.0005). The combination of physical examination and mammography worked best for assessment of the primary tumor (P = 0.003), whereas combining physical examination with sonography gave optimal evaluation of regional lymph nodes (P = 0.0001). In conclusion, physical examination is the best noninvasive predictor of the real size of locally advanced primary breast cancer, whereas sonography correlates better with the real dimensions of axillary lymph nodes. The combination of physical examination with either mammography or sonography significantly improves the accuracy of noninvasive assessment of tumor dimensions.
本研究的目的是将乳腺肿瘤及区域淋巴结的体格检查、超声和乳腺X线测量结果与病理结果相关联，并通过非侵入性方法评估新辅助化疗对临床肿瘤-淋巴结-转移（TNM）分期的影响。这是一项对100例在新辅助化疗前瞻性试验中登记并接受治疗的局部晚期乳腺癌患者的回顾性分析。所有患者均接受了四个周期含阿霉素的化疗方案，并在新辅助化疗前后通过体格检查、超声和乳腺X线检查对原发肿瘤和区域淋巴结进行了非侵入性评估，并在新辅助化疗完成后5周内接受了乳腺手术和腋窝淋巴结清扫术。临床测量与病理测量之间的相关性通过Spearman等级相关分析确定。使用比例优势模型来检验预测值。83例患者临床上可检测到原发肿瘤且有淋巴结转移。64例患者化疗后TNM分期降低。54%的患者原发肿瘤和淋巴结区域的临床反应一致；其余患者结果不一致。在原发肿瘤测量中，体格检查与病理结果相关性最佳（P = 0.0003），而超声是腋窝淋巴结大小最准确的预测指标（P = 0.0005）。体格检查与乳腺X线检查相结合对原发肿瘤评估效果最佳（P = 0.003），而体格检查与超声相结合对区域淋巴结的评估最为理想（P = 0.0001）。总之，体格检查是局部晚期原发性乳腺癌实际大小的最佳非侵入性预测指标，而超声与腋窝淋巴结的实际大小相关性更好。体格检查与乳腺X线检查或超声相结合可显著提高肿瘤大小非侵入性评估的准确性。
