Role of Ultrasound-guided Fine-needle Aspiration of Axillary Lymph Nodes in Preoperative Staging of Breast Cancer: Correlation with Final Pathological Results and Staging
JWC Wai, JLF Chiu, TS To, KH Lai, HHC Tsang, CW Siu, SCH Chan
Hong Kong J Radiol 2012;15:22-8
Objective: To retrospectively assess the sensitivity and specificity of ultrasound-guided fine-needle aspiration of axillary lymph nodes for preoperative breast cancer staging, using histological findings as a reference standard.
Methods: This was a retrospective study involving 95 consecutive adult patients having ultrasound-guided fineneedle aspiration of axillary lymph nodes performed from January to December 2010. In all, 45 (47%) of the patients had newly diagnosed carcinoma of breast. Four (4%) had axillary lymph node recurrences from a breast or lung tumour. The remainder (n = 46; 48%) did not have malignancy, showing incidentally enlarged reactive axillary lymph nodes only.
Results:The ages of the 45 women in the study group ranged from 30 to 78 (mean, 51) years. The mean primary breast cancer tumour size was 2.8 cm (range, 0.4-11.0 cm). Regarding the 45 axillary biopsies in this study, only six samples (13%) gave inconclusive results. Among these, four underwent surgery and three had positive lymph nodes. In all, 25 (56%) yielded positive fine-needle cytology findings, whilst in the remainder (n = 14; 31%), cytology was negative for malignancy. Twenty-three (51%) yielded metastatic carcinoma in the sentinel node biopsy or dissected axillary lymph node. Patients with positive ultrasound-guided fine-needle aspiration results and those with negative results were further analysed with their pathological results. Lymph nodes were more likely to be positive for metastatic disease with increased pathological tumour size. Ultrasound-guided fine-needle aspiration of axillary lymph nodes for preoperative staging is highly sensitive and specific, with satisfactory 95% confidence intervals.
Conclusion: Ultrasound-guided fine-needle aspiration of axillary lymph nodes was a highly sensitive and specific non-surgical means of staging breast cancer. Positive cytology for metastatic disease is sufficient to replace sentinel node biopsy and proceed to axillary lymph node dissection, and thus decrease the duration of anaesthesia and associated morbidity.
中文摘要
腋窩淋巴結超聲導引細針穿刺細胞學檢查對乳腺癌術前分期的角色： 與病理學結果和分期的關係
衛穎莊、趙朗峰、杜德信、黎國鴻、曾凱晴、蕭志偉、陳慈欽
目的：利用病理學結果作參考標準，回顧腋窩淋巴結超聲導引細針穿刺細胞學檢查對乳腺癌術前分 期的敏感性及特異性。
方法：本研究回顧2010年內所有進行腋窩淋巴結超聲導引細針穿刺細胞學檢查共95名成年病人。 其中45例（47%）為新確診乳腺癌，4例（4%）曾有乳腺或肺癌而現有腋窩淋巴結復發，其餘46例 （48%）無惡性腫瘤只為偶發性淋巴結反應性腫大。
結果：45名病人年齡介乎30至78歲（平均51歲）。原發性乳腺癌腫瘤平均2.8 cm大小（範圍0.4-11.0 cm）。45個腋窩活檢中，只有6例（13%）的結果不確定；其中4例接受手術，3例淋巴結結果陽性。 45例中有25例（56%）的細針穿刺細胞學結果呈陽性，其餘14例（31%）結果呈陰性。23例（51%） 前哨淋巴結活檢或手術切開腋窩淋巴結顯示轉移癌。超聲導引細針穿刺細胞學檢查呈陽性和陰性結 果的病人均再次進行病理學分析發現腫瘤越大，淋巴結有轉移癌的機會越高。腋窩淋巴結的超聲導 引細針穿刺細胞學檢查對乳腺癌術前分期有高敏感度及高特異性，並有滿意的95%可信區間。
結論：腋窩淋巴結超聲導引細針穿刺細胞學檢查對乳腺癌術前分期有高敏感度及特異性。轉移癌細 胞學呈陽性結果已經足以替代前哨淋巴結活檢，並繼而進行腋窩淋巴結切除，這樣可以減少麻醉時 間及減低有關患病率。