Sensitivity and Specificity of Preoperative Ultrasonography for Diagnosing Nodal Metastases in Patients with Breast Cancer

Zusammenfassung

Ziel: Bei einer rationalen Therapieplanung soll die Rate an axillären Lymphknoten-Entfernungen (ALNE) bei Patientinnen ohne Metastasen möglichst gering gehalten werden. Gleichzeitig soll die Zahl der Sentinel-Lymphknoten-Biopsien (SLNB) bei Patientinnen mit axillären Metastasen nicht unnötig hoch sein. Der präoperative axilläre Ultraschall ist ein ubiquitär verfügbares, nicht invasives Verfahren, welches die Beurteilung der Lymphknoten ermöglicht. Material und Methoden: Anhand von retrospektiv erhobenen Daten wurden die Sensitivität, Spezifität, der positive und negative Vorhersagewert und die Effizienz des präoperativen axillären Ultraschalls (US) untersucht. Es wurden 429 axilläre Ultraschalluntersuchungen in die Auswertung aufgenommen. Auf Grundlage des Ultraschallbefunds wurde die weitere Therapie festgelegt. Die Ultraschalluntersuchung wurde vor der Stanzbiospie des Tumors durchgeführt. Bei einem suspekten US-Befund wurde eine ALNE, bei einem nicht suspekt erscheinenden Befund eine SLNB durchgeführt. Ergebnisse: Insgesamt wiesen 146 / 429 (34 %) der Fälle Metastasen auf. Bei 75 / 146 (51 %) Fälle wurde der US als suspekt eingestuft und es wurde eine ALNE durchgeführt. Es wurden so insgesamt 17 % an SLNB eingespart. Von den 283 Fällen, die keine Metastasen aufwiesen, wurden 219 anhand des US richtig eingeordnet, sodass die Rate an ALNE, welche mit einer höheren postoperativen Morbidität assoziiert ist, um 51 % gesenkt wurde. Die Sensitivität des präoperativen Ultraschalls lag bei 53,6 %, die Spezifität bei 75,5 %, und der positive Vorhersagewert bei 77,3 %. Der negative Vorhersagewert und die Effizienz der Methode lagen bei 51,3 bzw. 68,5 %. Schlussfolgerung: Der Ultraschall stellt eine mäßig sensitive, aber durchaus spezifische Methode zur präoperativen Beurteilung der axillären Lymphknoten dar.

Abstract

Purpose: Rational therapy planning should aim to minimize the rate of axillary lymph node dissection (ALND) in patients without metastatic disease. By the same token, the frequency of sentinel lymph node biopsies (SLNB) should not be unnecessarily high in patients with axillary node disease. Preoperative axillary ultrasonography is a generally available noninvasive technique for assessing nodal status. Materials and Methods: Based on retrospective data, we analyzed the sensitivity, specificity, positive and negative predictive value, and efficiency of preoperative ultrasonography US. A total of 429 axillary ultrasonographic examinations were included, and the management decisions were based on the ultrasonographic findings. Patients with suspicious US results were scheduled for ALND, while patients with unremarkable findings underwent SLNB. Results: Axillary metastases were found in 146 of 429 (34 %) cases. In 75 of 429 (17 %) axillary examinations, ultrasonography revealed suspicious findings. In these cases, we proceeded with ALND, thereby reducing the number of SLNB by 17 %. 219 of 429 cases were classified correctly as not having metastasis, thus lowering the rate of ALND, which is associated with higher postoperative morbidity, by 51 %. Preoperative ultrasonography had a sensitivity of 53.6 %, specificity of 75.5 %, and a positive predictive value of 77.3 %. The negative predictive value was 51.3 % and the efficiency was 68.5 %. Conclusion: Ultrasonography is a moderately sensitive, but quite specific, preoperative method for assessing the axillary lymph nodes.

Key words

axillary ultrasound - breast cancer - sentinel lymph node

References

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