Evaluation of axillary status in patients with breast cancer using thin-section CT
Evaluation of axillary status in patients with breast cancer using thin-section CT
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DOI：
10.1007/s10147-007-0753-z
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发表时间：
2008-08-01
影响因子：
3.3
通讯作者：
Kinoshita, Takayuki
中科院分区：
文献类型：
--
作者：
Shien, Tadahiko;Akashi-Tanaka, Sadako;Kinoshita, Takayuki
背景近年来，乳腺癌患者的手术治疗已转向局部方法，评估患者的腋窝淋巴结状态是确定适当治疗策略的最重要因素。我们评估了术前使用对比增强计算机断层扫描（CE-CT）进行腋窝分期的有效性。在2000年至2003年期间，235例手术前接受CE-CT的可手术乳腺癌患者和137例接受新辅助化疗（NAC）并在NAC和手术前接受CE-CT的患者入选本研究。根据腋窝短轴径、形态、强化类型3个标准评价腋窝情况，并与病理结果进行对照。在未接受NAC的患者中，短轴直径大于5 mm的尺寸标准在预测淋巴结阳性状态方面的敏感性为78%，特异性为75%，准确性为76%。以短轴直径> 5 mm为大小标准，以结节内无脂肪密度为形态标准，其特异性和准确性分别为90%和81%，以早期强化为强化类型标准，其特异性和准确性分别为89%和78%。NAC治疗组患者的评估难度更大，NAC治疗组患者的基于尺寸标准的敏感性低于未接受NAC治疗组。这些结果表明，基于大小标准的CE-CT可用于评估乳腺癌患者的术前腋窝状态，但在接受NAC的患者中，评估更加困难，敏感性降低。
Background. In recent years, the surgical management of patients with breast cancer has shifted to a locoregional approach, and evaluating the patient's axillary lymph node status is of the greatest importance in determining the appropriate treatment strategy. We evaluated on the efficacy of preoperative axillary staging using contrast-enhanced computed tomography (CE-CT).Methods. Between 2000 and 2003, 235 patients with operable breast cancer who underwent CE-CT before surgery and 137 patients who received neoadjuvant chemotherapy (NAC) and underwent CE-CT before NAC and surgery were enrolled in this study. The axillary status was evaluated based on three criteria (short-axis diameter, shape, and enhancement type), and the diagnosis was correlated with the histopathological results.Results. In patients who did not receive NAC, the size criterion of a short-axis diameter of more than 5 mm provided a sensitivity of 78%, a specificity of 75%, and an accuracy of 76% in predicting node-positive status. According to the size criterion of a short-axis diameter of more than 5 mm and the shape criterion of the absence of intranodal fat density, the specificity and accuracy were 90% and 81%, respectively, and according to the enhancement type criterion of early enhancement, the corresponding values were 89% and 78%. Evaluation was more difficult in patients who received NAC and the sensitivity of the size-based criterion in the patients who received NAC was lower than in those who did not.Conclusion. These findings suggest that CE-CT based on size criteria is useful for evaluating the preoperative axillary status of breast cancer patients, but that evaluation is more difficult and the sensitivity is reduced in patients who have received NAC.