背景:在乳房切除术患者中缺乏标准化的影像学建议,导致了复发检测的差异性。
目的:描述超声在有症状的乳房切除术后患者评估中的发现并评估其诊断效能。
方法:这个单一的机构,回顾性研究包括对乳房切除术患者进行的749例连续诊断性胸壁超声检查,从2016年1月到2017年6月。胸壁超声评估有或没有重建的乳房切除术床。在乳房切除术前,电子健康记录被查询为原发性乳腺癌组织学,临床症状提示超声诊断,超声检查结果,随后的细胞学和病理学,和后续数据。排除了已知复发的患者,无症状患者,以及临床或影像学随访<2年的患者。进行描述性和比较性统计分析。
结果:在进行的749次超声检查中,58例恶性肿瘤被确定为7.7%(58/749)的恶性率,中位肿瘤大小为20毫米。诊断为恶性肿瘤的患者最常表现为明显的异常(79.3%,46/58)或皮肤变化(13.8%,8/58),很少有疼痛(1.7%,1/58).接受活检产生良性结果的患者最常表现为明显的异常(41.5%,287/691),疼痛(25.6%,177/691),或术后肿胀/疑似积液(17.8%,123/691)。诊断超声的灵敏度为91.4%(95%CI81.0,97.1),96.1%特异性(95%CI94.4,97.4),66.3%PPV3(95%CI57.4,74.1),癌症检测的阴性预测值为99.3%(95%CI98.3,99.7)。由于临床上可疑的皮肤变化,进行了皮肤穿刺活检后,有5例超声假阴性。
结论:胸壁超声对乳房切除术后有症状的患者乳腺癌复发的检测具有较高的敏感性和阴性预测价值。皮肤改变仍然是癌症复发的重要临床表现。
BACKGROUND: Lack of standardized imaging recommendations among mastectomy patients has led to variability in how recurrences are detected.
OBJECTIVE: To describe the findings and assess the diagnostic efficacy of ultrasound in the evaluation of symptomatic post-mastectomy patients.
METHODS: This single institution, retrospective study included 749 consecutive diagnostic chest wall ultrasound examinations performed in mastectomy patients, from January 2016 to June 2017. Chest wall ultrasound evaluated the mastectomy bed with or without reconstruction. Electronic health records were queried for the primary breast cancer histology prior to mastectomy, clinical symptoms prompting the diagnostic ultrasound, ultrasound findings, subsequent cytology and pathology, and follow-up data. Excluded were patients with a known recurrence, asymptomatic patients, and those with <2 years of clinical or imaging follow-up. Descriptive and comparative statistical analyses were performed.
RESULTS: Among the 749 ultrasounds performed, 58 malignancies were identified for a 7.7% (58/749) malignancy rate, with a median tumor size of 20 mm. Patients diagnosed with a malignancy most often presented with a
palpable abnormality (79.3%, 46/58) or skin changes (13.8%, 8/58) and rarely with pain (1.7%, 1/58). Patients who underwent a biopsy yielding a benign result most often presented with a
palpable abnormality (41.5%, 287/691), pain (25.6%,177/691), or postoperative swelling/suspected fluid collection (17.8%, 123/691). Diagnostic ultrasound yielded a 91.4% sensitivity (95% CI 81.0, 97.1), 96.1% specificity (95% CI 94.4, 97.4), 66.3% PPV3 (95% CI 57.4, 74.1), and 99.3% negative predictive value (95% CI 98.3, 99.7) for cancer detection. There were 5 false negative ultrasound cases after a skin punch biopsy was performed due to clinically suspicious skin changes.
CONCLUSIONS: Chest wall ultrasound has a high sensitivity and negative predictive value for detection of breast cancer recurrence in symptomatic patients after mastectomy. Skin changes remain an important clinical manifestation of a cancer recurrence.