Positron Emission Tomography-Computed Tomography in the Detection of Axillary Lymph Node Metastasis in Patients with Early Stage Breast Cancer
Positron Emission Tomography-Computed Tomography in the Detection of Axillary Lymph Node Metastasis in Patients with Early Stage Breast Cancer
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DOI：
10.1093/jjco/hyp019
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发表时间：
2009-05-01
影响因子：
2.4
通讯作者：
Song, Byung Joo
中科院分区：
文献类型：
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作者：
Chae, Byung Joo;Bae, Ja Seong;Song, Byung Joo
腋窝淋巴结(ALN)状态是乳腺癌最重要的预后因素。本研究的目的是评价正电子发射断层扫描-计算机断层扫描(PET-CT)在早期乳腺癌患者中的临床应用价值，并与乳腺超声和钼靶摄影进行比较。所有患者在前哨淋巴结(SLN)活检前均进行了PET-CT、乳腺超声和钼靶摄影检查。SLN活检后，所有患者均行ALN完全剥离。用标准苏木精-伊红染色技术评价ALN。对108例乳腺肿块的PET-CT、乳腺超声和钼靶X线表现与手术后病理结果进行对照分析。比较不同诊断模式的敏感性、特异性和准确性。应用受试者工作特征(ROC)曲线区评价诊断准确性，PET-CT诊断的敏感性、特异性和准确性分别为48.5%、84%和73.2%。超声诊断乳腺癌的敏感性为51.5%，特异性为89.3%，准确性为77.8%。钼靶摄影的敏感性为33.3%，特异性为96%，准确性为76.9%。对于ALN的侵犯，PET-CT成像、乳腺超声和钼靶摄影的ROC曲线下面积分别为0.662、0.704和0.647，与乳腺超声和钼靶相结合相比，PET-CT对ALN转移的诊断敏感性和准确性较低。因此，在决定采取适当的全身干预措施之前，PET-CT不是一种可靠的非侵入性评估ALN受累的方法，可以替代ALN解剖或SLN活检。
The status of axillary lymph nodes (ALNs) is the most important prognostic factor in breast cancer. The purpose of this study was to evaluate the clinical usefulness of ALN involvement by means of positron emission tomography-computed tomography (PET-CT) compared with breast sonography and mammography in patients with early breast cancer.This study involved 108 breast cancer patients with non-palpable ALNs. All patients had PET-CT, breast sonography and mammography imaging before sentinel lymph node (SLN) biopsy. After SLN biopsy, all patients underwent complete ALN dissection. ALNs were evaluated by standard hematoxylin and eosin staining techniques. The findings of PET-CT, breast sonography and mammography imaging of 108 patients were compared with pathologic findings after surgery. Sensitivity, specificity and accuracy of individual diagnostic modalities were compared. Diagnostic accuracy was evaluated applying receiver operating characteristic (ROC) curve areas.The sensitivity, specificity and accuracy of PET-CT imaging were 48.5%, 84% and 73.2%, respectively. The sensitivity, specificity and accuracy of breast sonography were 51.5%, 89.3% and 77.8%, respectively. The sensitivity, specificity and accuracy of mammography were 33.3%, 96% and 76.9%, respectively. For involvement of ALNs, PET-CT imaging, breast sonography and mammography had areas under the ROC curve of 0.662, 0.704 and 0.647, respectively.Compared with the combination of breast sonography and mammography, PET-CT was less sensitive and had less accuracy in detecting ALN metastasis. Consequently, PET-CT is not a reliable non-invasive modality for assessing ALN involvement that can replace ALN dissection or SLN biopsy before decisions are made on appropriate systemic interventions.