超声引导细针抽吸活检结合洗脱液细胞角蛋白19片段抗原21-1检测诊断乳腺癌腋窝淋巴结转移

Ultrasound-guided fine-needle aspiration biopsy combined with cytokeratin 19-fragments 21-1 in diagnosis of axillary lymph node metastasis in breast cancer

目的探讨高频超声引导下细针抽吸活检(FNA)细胞学检查结合细针抽吸洗脱液细胞角蛋白19片段抗原21-1(CYFRA 21-1)检测诊断乳腺癌腋窝淋巴结(ALN)转移的价值。方法选择148例拟接受手术、术前接受ALN超声检查的乳腺癌患者,共对156个可疑ALN行FNA细胞学检查;同时以1ml生理盐水冲洗穿刺针针管制成洗脱液,采用化学发光免疫法测定FNA洗脱液内细胞角蛋白19片段抗原21-1(FNA-CYFRA 21-1)浓度。对可疑ALN均做好体表标记,术中予以切除,术后送病理学检查。绘制ROC曲线,计算FNA-CYFRA 21-1浓度最佳诊断临界值,比较FNA细胞学、FNA-CYFRA 21-1及两者联合对诊断可疑ALN转移的效能。结果 156个可疑ALN,术后病理学确诊81个ALN转移(ALN转移组),75个未转移(ALN未转移组)。ALN转移组FNA-CYFRA 21-1浓度明显高于ALN未转移组(P=0.001),FNA-CYFRA 21-1诊断ALN转移的最佳诊断临界值为2.95ng/ml,AUC为0.921[95%CI(0.877,0.966)]。FNA-CYFRA 21-1与FNA比较,诊断ALN转移的敏感度和阴性预测值差异均有统计学意义(P<0.05);两者联合与FNA比较,诊断ALN转移的敏感度、阴性预测值和准确率差异均有统计学意义(P均<0.05)。8个ALN FNA细胞学检查呈假阴性,结合FNA-CYFRA 21-1检测后获得正确诊断。结论 FNA细胞学检查与FNA-CYFRA 21-1检测是诊断乳腺癌ALN转移的有效手段,二者联合可显著提高诊断敏感度和准确率。

Objective To explore the value of high-frequency ultrasound-guided fine-needle aspiration(FNA)biopsy combined with cytokeratin 19-fragments 21-1(CYFRA 21-1)in diagnosis of axillary lymph node(ALN)metastasis in breast cancer.Methods Totally 148 breast cancer patients preparing for surgery were recruited and underwent ultrasound examination of ALN preoperatively.FNA was performed in 156 ALNs with suspected metastasis,and then the eluents were obtained by flushing aspiration needle with 1 ml normal saline.The cytokeratin 19-fragment antigen 21-1(FNA-CYFRA 21-1)of elution was measured by chemiluminescence immunoassay.All ALN underwent FNA were labeled before surgery and sent to histopathological examination.ROC curve was drawn to get the optimal diagnostic threshold of FNA-CYFRA 21-1 concentration.The diagnostic efficacy of FNA cytology,FNA-CYFRA 21-1 and both for ALN was evaluated.Results In 156 suspicious ALNs,eighty-one ALNs of metastasis(metastasis group)and 75 ALNs without metastasis(benign group)were confirmed by postoperative pathology.The average value of FNA-CYFRA 21-1 in metastasis group was significantly higher than that in benign group(P=0.001).The optimal diagnostic value of FNA-CYFRA 21-1 in diagnosis of ALNs metastasis was 2.95 ng/ml,and the AUC was 0.921(95%CI[0.877,0.966]).The difference of sensitivity and negative predictive value between FNA-CYFRA 21-1 and FNA was statistically significant(P<0.05).The difference of sensitivity,negative predictive value and accuracy between FNA-CYFRA 21-1 combined with FNA and FNA were statistically significant(all P<0.05).Eight FNA false-negative ALNs were diagnosed correctly with FNA-CYFRA 21-1 testing.Conclusion FNA cytology and FNA-CYFRA 21-1 detection are effective methods for diagnosis of ALN metastasis in patients with breast cancer.Combination of them can significantly improve diagnostic sensitivity and accuracy.