Preoperative Sonographic Assessment of Axillary Lymph Nodes in Newly Diagnosed Invasive Breast Cancer
KH Wong, YL Li, MKH Yam, HKY Tam, GKF Tam, APY Tang
Hong Kong J Radiol 2019;22:130-41
https://doi.org/10.12809/hkjr1916924
Objective: To assess the sonographic features and fine needle aspiration of ipsilateral metastatic axillary lymph nodes of newly diagnosed invasive breast cancer.
Methods: This was a retrospective review of the sonographic features of ipsilateral axillary lymph nodes of patients with newly diagnosed invasive breast cancers, attending a single radiology centre from January 2014 to December 2016. Among 449 axillae review, 362 axillae of 355 breast cancer patients with available sonographic images and surgical histopathology or positive fine needle aspiration cytology were analysed. Qualitative morphological assessments and quantitative measurements of the axillary lymph nodes were performed.
Results: Various dimensions, areas, and ratios of the entire lymph node and its cortex were associated with nodal metastasis (p < 0.001), with the maximal cortical thickness showed superior performance. Using a 4-point grading system, the sonographic morphological features including focal cortical thickening, hilar displacement or replacement, and perinodal infiltration were associated with nodal metastasis (p < 0.001) with sensitivity 65.2% (95% confidence interval [CI] = 58.2%-71.8%) and specificity 96.9% (95% CI = 92.9%-99.0%). With the surgical histopathological result as the reference standard, the ultrasound-guided fine needle aspiration cytology showed moderate sensitivity 74.7% (95% CI = 63.3%-84.0%) and high specificity 100% (95% CI = 92.3%-100%).
Conclusion: Axillary ultrasound helps in preoperative axillary nodal staging of patients with invasive breast cancer. Ultrasound-guided fine needle aspiration cytology offers additional information to the metastatic nodal status with high specificity.
Author affiliation(s):
KH Wong, MKH Yam, HKY Tam, GKF Tam: Department of Radiology, North District Hospital, Sheung Shui, Hong Kong
YL Li: Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
APY Tang: Diagnostic Radiology Department, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
中文摘要
侵襲性乳腺癌新發病例的腋下淋巴結術前超聲檢查
黃健開、李恩年、任啟豪、譚家盈、譚國輝、鄧珮儀
目的：評估侵襲性乳腺癌新發病例的同側腋下淋巴結轉移的超聲影像特徵和細針抽吸檢查。
方法：回顧性分析2014年1月至2016年12月於一所放射科受檢的侵襲性乳腺癌新發病例的同側腋下淋巴結超聲影像特徵。在449項腋下檢查中，對355名乳腺癌病人的362項同時備有可供查閱的超聲影像及外科組織病理診斷結果或細針抽吸細胞學陽性結果的病例進行了分析， 包括腋下淋巴結定性形態評估和定量測量。
結果：淋巴結及其皮質的各種大小、面積及比例與淋巴結轉移相關（p < 0.001），其中以皮質最大厚度相關最為顯著。使用四級評分方法評估超聲影像，包括局部淋巴結皮質增厚、淋巴結門移位或侵犯及淋巴結周邊浸潤，此評分方法與淋巴結轉移顯著相關（p < 0.001），敏感性為65.2%（95%置信區間：58.2%-71.8%），特異性為96.9%（95%置信區間：92.9%-99.0%）。以外科組織病理診斷結果為參考標準，超聲引導細針抽吸細胞學診斷對腋下淋巴結轉移顯示中等敏感性（74.7%，95%置信區間：63.3%-84.0%）及高度特異性100%（95%置信區間：92.3%-100%）。
結論：腋下超聲波檢查有助侵襲性乳癌患者的術前淋巴結分期。超聲波引導細針抽吸細胞學為淋巴結轉移提供高特異度信息。