Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnostic Value of CYFRA 21-1 Measurement in Fine-Needle Aspiration Washouts for Detection of Axillary Recurrence in Postoperative Breast Cancer Patients

유방암 수술 후 액와림프절 재발 진단에 있어서의 미세침세척액 CYFRA 21-1의 진단적 가치

  • So Yeon Won (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Eun-Kyung Kim (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Hee Jung Moon (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Jung Hyun Yoon (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Vivian Youngjean Park (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Min Jung Kim (Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine)
  • 원소연 (연세대학교 의과대학 세브란스병원 영상의학과, 방사선의과학연구소) ;
  • 김은경 (연세대학교 의과대학 세브란스병원 영상의학과, 방사선의과학연구소) ;
  • 문희정 (연세대학교 의과대학 세브란스병원 영상의학과, 방사선의과학연구소) ;
  • 윤정현 (연세대학교 의과대학 세브란스병원 영상의학과, 방사선의과학연구소) ;
  • 박영진 (연세대학교 의과대학 세브란스병원 영상의학과, 방사선의과학연구소) ;
  • 김민정 (연세대학교 의과대학 세브란스병원 영상의학과, 방사선의과학연구소)
  • Received : 2018.11.21
  • Accepted : 2019.07.15
  • Published : 2020.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose The objective of this study was to evaluate the diagnostic value and threshold levels of cytokeratin fragment 21-1 (CYFRA 21-1) in fine-needle aspiration (FNA) washouts for detection of lymph node (LN) recurrence in postoperative breast cancer patients. Materials and Methods FNA cytological assessments and CYFRA 21-1 measurement in FNA washouts were performed for 64 axillary LNs suspicious for recurrence in 64 post-operative breast cancer patients. Final diagnosis was made on the basis of FNA cytology and follow-up data over at least 2 years. The concentration of CYFRA 21-1 was compared between recurrent LNs and benign LNs. Diagnostic performance and cut-off value were evaluated using a receiver operating characteristic curve. Results Regardless of the non-diagnostic results, the median concentration of CYFRA 21-1 in recurrent LNs was significantly higher than that in benign LNs (p < 0.001). The optimal diagnostic cut-off value was 1.6 ng/mL. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CYFRA 21-1 for LN recurrence were 90.9%, 100%, 100%, 98.1%, and 98.4%, respectively. Conclusion Measurement of CYFRA 21-1 concentration from ultrasound-guided FNA biopsy aspirates showed excellent diagnostic performance with a cut-off value of 1.6 ng/mL. These results indicate that measurement of CYFRA 21-1 concentration in FNA washouts is useful for the diagnosis of axillary LN recurrence in post-operative breast cancer patients.

목적 이 연구의 목적은 유방암으로 수술한 환자에서 림프절 재발을 진단함에 있어 미세침흡인세척액 cytokeratin fragment 21-1 (이하 CYFRA 21-1) 측정의 진단적 가치와 적절한 역치값을 평가하는 것이다. 대상과 방법 64명의 유방암 수술을 받은 환자에서 재발이 의심되는 총 64개의 림프절에 대해 미세침흡인세포검사와 미세침세척액 CYFRA 21-1 검사를 시행하였다. 최종 진단은 fine-needle aspiration 세포검사 및 2년 이상의 추적관찰로 하였다. 재발 림프절과 양성 림프절의 CYFRA 21-1의 농도를 비교하였다. 진단수행도와 역치값은 수신기작동특성곡선을 이용하여 구했다. 결과 비진단적 결과와 상관없이, CYFRA 21-1의 중간 농도는 양성 림프절보다 재발 림프절에서 유의하게 높았다(p < 0.001). 적절한 역치값은 1.6 ng/mL였다. 림프절 재발에 대한 CYFRA 21-1의 민감도, 특이도, 양성예측도, 음성예측도 및 정확도는 각각 90.9%, 100%, 100%, 98.1%, 98.4%였다. 결론 미세침세척액에서 CYFRA 21-1 농도 측정은 역치값을 1.6으로 하였을 때 우수한 진단수 행도를 보여주었다. 이 결과는 미세침세척액 CYFRA 21-1 농도 측정이 유방암 수술 환자에서 액와림프절 재발을 진단하는데 있어 유용함을 보여준다.

Keywords

References

  1. Cools-Lartigue J, Meterissian S. Accuracy of axillary ultrasound in the diagnosis of nodal metastasis in invasive breast cancer: a review. World J Surg 2012;36:46-54 
  2. Jain A, Haisfield-Wolfe ME, Lange J, Ahuja N, Khouri N, Tsangaris T, et al. The role of ultrasound-guided fine-needle aspiration of axillary nodes in the staging of breast cancer. Ann Surg Oncol 2008;15:462-471 
  3. Park SH, Kim MJ, Park BW, Moon HJ, Kwak JY, Kim EK. Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol 2011;18:738-744 
  4. Van Rijk MC, Deurloo EE, Nieweg OE, Gilhuijs KG, Peterse JL, Rutgers EJ, et al. Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol 2006;13:31-35 
  5. Koelliker SL, Chung MA, Mainiero MB, Steinhoff MM, Cady B. Axillary lymph nodes: US-guided fine-needle aspiration for initial staging of breast cancer--correlation with primary tumor size. Radiology 2008;246:81-89 
  6. Deurloo EE, Tanis PJ, Gilhuijs KG, Muller SH, Kroger R, Peterse JL, et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer 2003;39:1068-1073 
  7. Choi JS, Kim MJ, Moon HJ, Kim EK, Yoon JH. False negative results of preoperative axillary ultrasound in patients with invasive breast cancer: correlations with clinicopathologic findings. Ultrasound Med Biol 2012;38:1881-1886 
  8. Kim MJ, Park BW, Lim JB, Kim HS, Kwak JY, Kim SJ, et al. Axillary lymph node metastasis: CA-15-3 and carcinoembryonic antigen concentrations in fine-needle aspirates for preoperative diagnosis in patients with breast cancer. Radiology 2010;254:691-697 
  9. Yoon JH, Han KH, Kim EK, Moon HJ, Kim MJ, Suh YJ, et al. Fine-needle aspirates CYFRA 21-1 is a useful tumor marker for detecting axillary lymph node metastasis in breast cancer patients. PLoS One 2013;8:e57248 
  10. Choi JS, Han KH, Kim EK, Moon HJ, Yoon JH, Kim MJ. Fine-needle aspirate CYFRA 21-1, an innovative new marker for diagnosis of axillary lymph node metastasis in breast cancer patients. Medicine (Baltimore) 2015;94:e811 
  11. Tsujimoto M, Nakabayashi K, Yoshidome K, Kaneko T, Iwase T, Akiyama F, et al. One-step nucleic acid amplification for intraoperative detection of lymph node metastasis in breast cancer patients. Clin Cancer Res 2007;13:4807-4816 
  12. Nakata B, Ogawa Y, Ishikawa T, Ikeda K, Kato Y, Nishino H, et al. Serum CYFRA 21-1 is one of the most reliable tumor markers for breast carcinoma. Cancer 2000;89:1285-1290 
  13. Nakata B, Takashima T, Ogawa Y, Ishikawa T, Hirakawa K. Serum CYFRA 21-1 (cytokeratin-19 fragments) is a useful tumour marker for detecting disease relapse and assessing treatment efficacy in breast cancer. Br J Cancer 2004;91:873-878 
  14. Lu WL, Jansen L, Post WJ, Bonnema J, Van de Velde JC, De Bock GH. Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis. Breast Cancer Res Treat 2009;114:403-412 
  15. Galper S, Recht A, Silver B, Manola J, Gelman R, Schnitt SJ, et al. Factors associated with regional nodal failure in patients with early stage breast cancer with 0-3 positive axillary nodes following tangential irradiation alone. Int J Radiat Oncol Biol Phys 1999;45:1157-1166 
  16. Harris EE, Hwang WT, Seyednejad F, Solin LJ. Prognosis after regional lymph node recurrence in patients with stage I-II breast carcinoma treated with breast conservation therapy. Cancer 2003;98:2144-2151 
  17. Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312:665-673 
  18. Leung S, Otmezguine Y, Calitchi E, Mazeron JJ, Le Bourgeois JP, Pierquin B. Locoregional recurrences following radical external beam irradiation and interstitial implantation for operable breast cancer--a twenty three year experience. Radiother Oncol 1986;5:1-10 
  19. Pierquin B, Mazeron JJ, Glaubiger D. Conservative treatment of breast cancer in Europe: report of the Groupe Europeen de Curietherapie. Radiother Oncol 1986;6:187-198 
  20. Kauczor HU, Voges EM, Wieland-Schneider C, Mitze M, Thelen M. Value of routine abdominal and lymph node sonography in the follow-up of breast cancer patients. Eur J Radiol 1994;18:104-108 
  21. Dian D, Straub J, Scholz C, Mylonas I, Rack B, Sommer H, et al. Influencing factors for regional lymph node recurrence of breast cancer. Arch Gynecol Obstet 2008;277:127-134 
  22. Hammon M, Dankerl P, Janka R, Wachter DL, Hartmann A, Schulz-Wendtland R, et al. Fine needle aspiration cytology of lymph nodes in breast cancer follow-up is a feasible alternative to watchful waiting and to histology. BMC Womens Health 2015;15:114 
  23. Alvarenga CA, Paravidino PI, Alvarenga M, Dufloth R, Gomes M, Zeferino LC, et al. Expression of CK19 in invasive breast carcinomas of special histological types: implications for the use of one-step nucleic acid amplification. J Clin Pathol 2011;64:493-497 
  24. Molina R, Agusti C, Filella X, Jo J, Joseph J, Gimenez N, et al. Study of a new tumor marker, CYFRA 21-1, in malignant and nonmalignant diseases. Tumour Biol 1994;15:318-325 
  25. Suh YJ, Kim MJ, Kim J, Yoon JH, Moon HJ, Kim EK. Tumor markers in fine-needle aspiration washout for cervical lymphadenopathy in patients with known malignancy: preliminary study. AJR Am J Roentgenol 2011;197:W730-W736