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Nichtinvasive bildgebende Verfahren zum präoperativen axillären Lymphknotenstaging beim Mammakarzinom

Non-invasive imaging modalities for preoperative axillary lymph node staging in patients with breast cancer

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Zusammenfassung

Die Wächterlymphknotenbiopsie hat sich in den letzten 10 Jahren für das axilläre Lymphknotenstaging des Mammakarzinoms fest etabliert. Durch präoperative bildgebende Verfahren kann getestet werden, ob sich Patientinnen für eine Wächterlymphknotenbiopsie eignen oder direkt einer axillären Dissektion unterzogen werden sollten. Diese bildgebenden Verfahren müssen sich in erster Linie durch einen hohen positiven Vorhersagewert (PVW) auszeichnen. Die B-Bild-Sonographie ist diesbezüglich bisher am besten evaluiert. Sie liefert eindeutige morphologische Kriterien für einen hohen PVW (>90%). Die Sensitivität liegt dabei allerdings kaum über 50%. Bisher ist nicht erwiesen, dass andere Verfahren wie die Duplexsonographie, die MRT, die CT oder Szintigraphie eine bessere Sensitivität bei hohem PVW liefern. Lediglich für die Positronenemissionstomographie (PET) bestehen Hinweise, dass die Sensitivität gesteigert werden kann. Dies muss durch weitere Studien untermauert werden, zumal das axilläre Lymphknotenstaging mittels PET oder PET/CT eine zunehmende Bedeutung im Rahmen eines initialen Ganzkörperstagings des Mammakarzinoms erlangen wird.

Abstract

In the last decade sentinel lymph node biopsy has become a well-established method for axillary lymph node staging in patients with breast cancer. Using preoperative imaging modalities it can be tested whether patients are suitable for sentinel node biopsy or if they should directly undergo an axillary dissection. The imaging modalities used must be mainly characterized by a high positive predictive value (PPV). For this question B-mode ultrasound is the best evaluated method and provides clear morphological signs for a high PPV (>90%) but the sensitivity barely exceeds 50%. It has not yet been proven whether other modalities such as duplex sonography, magnetic resonance imaging, computed tomography (CT) or scintigraphy might achieve a higher sensitivity while still maintaining a high PPV. There is only some evidence that positron emission tomography (PET) might achieve a higher sensitivity. This should be confirmed by further studies because PET or PET/CT will play an increasing role for an initial whole body staging in patients with breast cancer in the near future.

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  1. Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    K. Wasser, A. Schnitzer & S.O. Schoenberg

  2. Institut für medizinische Statistik, Universitätsmedizin Mannheim, Mannheim, Deutschland

    J. Brade

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  1. K. Wasser
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Wasser, K., Schnitzer, A., Brade, J. et al. Nichtinvasive bildgebende Verfahren zum präoperativen axillären Lymphknotenstaging beim Mammakarzinom. Radiologe 50, 1022–1029 (2010). https://doi.org/10.1007/s00117-010-2072-z

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