Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma
Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma
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DOI：
10.1002/cncr.10786
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发表时间：
2002-09-01
期刊：
影响因子：
6.2
通讯作者：
Hunt, KK
中科院分区：
文献类型：
--
作者：
Krishnamurthy, S;Sneige, N;Hunt, KK
背景资料。在乳腺癌的初步分期中，超声(US)在确定腋窝淋巴结受累方面比单独的体检更敏感。由于良性和不确定淋巴结的淋巴组织学特征偶尔会重叠，超声不确定/可疑淋巴结的细针吸取(FNA)可以提供比单独US更明确的诊断。本研究旨在探讨超声引导下的细针吸取细胞学检查在乳腺癌早期分期中对不确定/可疑/转移性腋窝淋巴结的诊断准确性。方法：对103例未触及的可疑/可疑/转移性腋窝淋巴结进行细胞学检查，并与腋窝清扫后整个腋窝的病理组织学结果进行比较。当所有淋巴结转移阴性时，最终的腋窝淋巴结状态被归类为阴性，或者当一个或多个淋巴结有转移证据时，腋窝淋巴结状态被归类为阳性。结果：103例患者中，51例(49.5%)超声引导下细针吸取细胞学检查与病理组织学检查均阳性。103例中，24例(23.3%)两者均为阴性。FNA假阳性16例(15.5%)，其原因是转移性淋巴结对新辅助化疗的完全反应。12例(11.6%)超声引导下FNA为阴性，但在组织切片上可见转移。所有有3个或3个以上淋巴结转移的病例，93%的转移灶直径大于0.5 mm，超声引导下FNA均能检出。发现转移灶小于0.5 cm的淋巴结的概率为44%。超声引导下FNA诊断乳腺癌的敏感性为86.4%，特异性为100%，诊断准确率为79.0%，阳性预测值为100%，阴性预测值为67%。导致初始和最终腋窝淋巴结状态不一致的常见原因包括超声检查时未能显示所有淋巴结，小范围转移，以及术前新辅助化疗。
BACKGROUND. Ultrasound (US) is more sensitive than physical examination alone in determining axillary lymph node involvement during preliminary staging of breast carcinoma. Due to occasional overlap of sorrographic features of benign and indeterminate lymph nodes, fine-needle aspiration (FNA) of sonographically indeterminate/suspicious lymph nodes can provide a more definitive diagnosis than US alone. This study was under-taken to determine the diagnostic accuracy of US-guided FNA of indeterminate/suspicious/metastatic-appearing axillary lymph nodes during the initial staging of breast carcinoma.METHODS. The cytology of 103 cases of US-guided FNA of nonpalpable indeterminate /suspicious/metastatic-appearing lymph nodes was compared with the final histopathologic status of the entire axilla after axillary dissection. The final axillary lymph node status was categorized as either negative when all lymph nodes were negative for metastasis or positive when there was evidence of metastasis in one or more lymph nodes. The sensitivity, specificity, diagnostic accuracy, and false-negative rate of US-guided FNA of nonpalpable axillary lymph nodes in the preliminary staging process were calculated.RESULTS. In 51 of 103 cases (49.5%), the US-guided FNA and histopathology were both positive for metastasis. In 24 of 103 cases (23.3%), both were negative. The apparent false-positive FNA in 16 (15.5%) cases was explained by the complete response of the metastatic lymph nodes to neoadjuvant chemotherapy in the interval between FNA and axillary dissection. In 12 cases (11.6%), US-guided FNA was negative, but metastasis was seen in histologic sections. All cases with three or more lymph nodes with metastatic disease and 93% of those with metastatic deposit measuring more than 0.5 mm were detected by US-guided FNA. The probability of detecting lymph nodes with smaller metastatic deposit measuring less than 0.5 cm was 44%. The overall sensitivity of US-guided FNA was 86.4%, the specificity was 100%, the diagnostic accuracy was 79.0%, the positive predictive value was 100%, and the negative predictive value was 67%.CONCLUSIONS. US-guided FNA of nonpalpable indeterminate and suspicious axillary lymph nodes is a simple, minimally invasive, and reliable technique for the initial determination of axillary lymph node status in breast carcinoma. The common causes of discrepancy between the initial and final axillary lymph node status include failure to visualize all lymph nodes during US examination, small-sized metastases, and preoperative neoadjuvant chemotherapy.