腋窝超声检查对乳腺癌患者非前哨淋巴结转移的判断价值研究

The value of axillary ultrasonography in predicting non-sentinel lymph node metastasis in breast cancer patients

目的:前哨淋巴结活组织检查已成为评估乳腺癌患者腋窝淋巴结状态的标准方法。对仅前哨淋巴结阳性而非前哨淋巴结无转移的乳腺癌患者,施行腋窝淋巴结清扫术有过度治疗之嫌。本研究探索腋窝超声检查结果可否用来预测乳腺癌患者的非前哨淋巴结转移情况。方法 :对在2008年1月-2012年12月间经同组医生手术治疗的原发性浸润性乳腺癌患者的临床资料进行回顾性分析。这些患者均接受过术前腋窝超声检查,且未接受过新辅助化疗或新辅助内分泌治疗。比较这些患者的术前腋窝淋巴结超声检查结果与腋窝淋巴结清扫术后或前哨淋巴结活组织检查的病理结果。结果:共入组154例患者,其中117例(76.0%)的腋窝超声检查结果为阴性。对102例(66.2%)患者进行了前哨淋巴结活组织检查,有15例的前哨淋巴结为阳性,对她们施行了腋窝淋巴结清扫术,但其中有7例的非前哨淋巴结为阴性。在117例腋窝超声检查结果为阴性的患者中,113例(96.6%)无非前哨淋巴结转移。应用腋窝超声检查结果预测非前哨淋巴结转移的敏感度、特异度、阴性预测率和准确度分别为81.8%、85.6%、96.6%和85.1%。结论 :对原发性浸润性乳腺癌患者,腋窝超声检查结果为阴性可用作无非前哨淋巴结转移的预测因素。对这些患者,可仅进行前哨淋巴结活组织检查,但不需依据活组织检查结果来决定是否施行腋窝淋巴结清扫术。

Objective： Sentinel lymph node （SLN） biopsy is considered to be the standard procedure in staging the axilla status in breast cancer patients. Axillary lymph node dissection （ALND） may be an over-treatment for patients with positive SLN alone while without non-sentinel lymph nodes （non-SLN） metastasis. The purpose of this study is to evaluate whether axillary ultrasonography （AUS） can predict involvement of non-SLN. Methods： The data from the primary invasive breast cancer patients who were operated by one surgeon from January, 2008 through December, 2012 were retrospectively reviewed. All the recruited patients received preoperative AUS but neither neo-adjuvant chemotherapy nor endocrine therapy. The results of AUS were compared with the pathological reports of ALND or SLN biopsy. Results： One hundred and fifty-four patients were included, in which 117 patients （76.0%） had negative AUS finding. One hundred and two patients （66.2%） underwent SLN biopsy at time of definitive surgery. Fifteen patients with positive SLN underwent ALND, in which 7 patients had negative non- SLN. Among the 117 patients with negative AUS finding, there were 113 cases （96.6%） with a negative non-SLN. The sensitivity,specificity, negative predictive value, and accuracy of AUS in predicting non-SLN involvement were 81.8%, 85.6%, 96.6%, and 85.1%, respectively. Conclusion： A negative AUS may be a predictor of noninvolvement of non-SLN in patients with primary invasive breast cancer. Patients with negative AUS may undergo SLN biopsy only, regardless of the SLN status.