Comparisons of Positron Emission Tomography/Computed Tomography and Ultrasound Imaging for Detection of Internal Mammary Lymph Node Metastases in Patients With Breast Cancer and Pathologic Correlation by Ultrasound-Guided Biopsy Procedures
Comparisons of Positron Emission Tomography/Computed Tomography and Ultrasound Imaging for Detection of Internal Mammary Lymph Node Metastases in Patients With Breast Cancer and Pathologic Correlation by Ultrasound-Guided Biopsy Procedures
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DOI：
10.7863/ultra.34.8.1385
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发表时间：
2015-08-01
影响因子：
2.3
通讯作者：
Lee, Ah Won
中科院分区：
文献类型：
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作者：
An, Yeong Yi;Kim, Sung Hun;Lee, Ah Won
目的：比较[F-18]氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(PET/CT)和超声成像(US)与超声引导下活检病理结果的诊断性能，评价超声在乳腺癌内乳房淋巴结(LN)转移检测中的作用。方法：2008年1月至2012年12月，37例乳腺癌患者(年龄中位数51.4岁，年龄40~79岁)在超声引导下进行内乳房淋巴结转移活检。复习病历、影像和报告，并与病理结果对照。结果：内乳淋巴结转移率为78.4%。所有活检均安全进行，无重大并发症发生。只有8.1%的样品不满意。转移组和良性组在病变大小(P=.0002)、PET/CT标准化摄取值(P=.001.5)、活检方法(P=.002)和标本充分性(P=.007)方面有统计学差异。在所回顾的临床因素中，只有并发远处转移与内乳房淋巴结转移相关(P<；.0001)。B超初诊、初诊联合复查和PET/CT诊断内乳房淋巴结转移的敏感性分别为76.7%、96.7%和92.9%(P=0.017)。在亚组分析中，发现的唯一显著差异是初始US和联合US之间的敏感性(P=0.019)。在受试者操作特征曲线分析中，使用标准化摄取标准的PET/CT的曲线下面积(0.87)高于使用大小标准的US的曲线下面积(0.83)，但这种差异并不显著。结论-尽管PET/CT是评估内乳房淋巴结转移的最佳无创性方法，但如果在标准US监测乳腺癌患者时常规评估内乳房LN，超声也是有用的。此外，超声引导下的活检可以立即对任何可疑的转移进行，并产生高阳性率而不会出现严重的并发症。
Objectives-To compare the diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and ultrasound imaging (US) with pathologic results obtained by US-guided biopsy and to evaluate the role of US in detecting internal mammary lymph node (LN) metastases in patients with breast cancer.Methods-Between January 2008 and December 2012,37 patients with breast cancer (median age, 51.4 years; range, 40-79 years) underwent US-guided biopsy for suspected internal mammary LN metastases. Medical records, radiologic images, and reports were reviewed and correlated with pathologic results.Results-The positive internal mammary LN metastasis rate was 78.4%. All biopsies were performed safely without major complications. Only 8.1% of obtained samples were unsatisfactory. There were statistically significant differences in lesion size (P = .0002), standardized uptake value on PET/CT (P = .001.5), biopsy methods (P = .002), and specimen adequacy (P = .007) between metastatic and benign groups. Of the clinical factors reviewed, only concurrent distant metastasis was correlated with internal mammary LN metastasis (P < .0001). Sensitivities for detecting internal mammary LN metastases were 76.7%, 96.7%, and 92.9% for initial US examinations, initial US combined with second-look US for initially missed cases, and PET/CT, respectively (P = .017). In a subgroup analysis, the only significant difference found was in sensitivities between initial and combined US (P = .019). In a receiver operating characteristic curve analysis, the area under the curve for PET/CT using standardized uptake criteria (0.87) was higher than that for US using size criteria (0.83); however, this difference was not significant.Conclusions-Although PET/CT is the best noninvasive method for evaluating internal mammary LN metastases, US is also useful if internal mammary LN evaluation is routine during standard US surveillance of patients with breast cancer. Additionally, US-guided biopsies could be performed immediately on any suspected metastases and yield a high positive rate without serious complications.