B超判断乳腺癌腋窝淋巴结转移状态的临床研究

发布时间：2018-09-09 13:33

【摘要】：目的探讨B超判断乳腺癌腋窝淋巴结转移状态的临床应用价值。方法纳入2014年2~12月军事医学科学院附属医院乳腺外科200例女性初治乳腺疾病患者,中位年龄50岁。其中乳腺癌患者153例,乳腺炎患者2例,巨大纤维瘤1例,纤维腺瘤44例。良性乳腺疾患腋窝淋巴结不作处理;乳腺癌患者腋窝淋巴结行前哨淋巴结活检,转移阳性或临床可疑时行腋窝淋巴结清扫。所有淋巴结均行石蜡病理检查。由具有20年以上B超检查经验的医师在不明原发病诊断情况下评估腋窝淋巴结转移状态。根据淋巴结B超影像学特征结合B超医师经验,将患者分为腋窝淋巴结转移组、可疑组和未转移组。对照术后病理诊断结果,分析B超判断腋窝淋巴结转移的灵敏度、特异度、阳性及阴性预测值、假阴性率及假阴性患者腋窝淋巴结肿瘤转移负荷,并对B超各参数在判断腋窝淋巴结转移的作用进行单因素分析。结果 B超判断上述3组的转移率分别为84.51%、45.16%和7.14%;转移组+未转移组B超判断腋窝淋巴结的转移的灵敏度、特异度、阳性及阴性预测值分别为89.6%、89.1%、84.5%和92.7%;转移组+未转移组B超判断腋窝淋巴结转移与病理诊断结果的一致性分析显示,Kappa值为0.779;7例B超判断假阴性患者,腋窝淋巴结转移负荷均只有1枚。单因素分析提示,淋巴结纵径≥1 cm,其转移率明显高于纵径1 cm,分别为44.2%/14.3%(P0.001);淋巴结纵横比≤1.5的淋巴结转移率显著高于纵横比1.5,为65.6%/35.1%(P0.001);淋巴结皮质厚度≥3 mm的转移率达67.5%,3 mm的淋巴结转移率仅为1.2%(P0.001);淋巴结出现中央型或混合型血流信号,淋巴结转移率分别达75%及79%(P0.001)。结论 B超可准确判断部分患者腋窝淋巴结转移状态;假阴性患者腋窝淋巴结转移负荷较低;纵径≥1 cm、纵横比≤1.5、皮质厚度≥3 mm及出现中央型或混合型血流信号与淋巴结转移相关。对于早期乳腺癌,B超可能是潜在的替代前哨腋窝淋巴结活检进行腋窝淋巴结分期的手段。
[Abstract]:Objective to evaluate the clinical value of B-ultrasound in the diagnosis of axillary lymph node metastasis in breast cancer. Methods 200 female patients with breast diseases were enrolled in the hospital affiliated to the Academy of military Medical Sciences from February to December 2014. The median age was 50 years old. There were 153 cases of breast cancer, 2 cases of mastitis, 1 case of giant fibroma and 44 cases of fibroadenoma. The axillary lymph nodes of patients with benign breast diseases were not treated, and the axillary lymph nodes of breast cancer patients underwent sentinel lymph node biopsy, and axillary lymph node dissection was performed when metastasis was positive or clinically suspicious. All lymph nodes were examined by paraffin wax pathology. The status of axillary lymph node metastasis was evaluated by a physician with more than 20 years of experience in ultrasonic examination under unknown diagnosis of primary disease. The patients were divided into axillary lymph node metastasis group, suspicious group and non-metastatic group according to the imaging features of B-ultrasound and experience of B-ultrasound. The sensitivity, specificity, positive and negative predictive value of axillary lymph node metastasis, false negative rate and metastasis load of axillary lymph node were analyzed. The single factor analysis of the role of B-ultrasound parameters in judging axillary lymph node metastasis was carried out. Results the metastatic rates of the three groups were 45.16% and 7.14%, respectively, and the sensitivity and specificity of B-ultrasound in the non-metastasis group were evaluated. The positive and negative predictive values were 84.5% and 92.7%, respectively. The load of axillary lymph node metastasis was only 1. Univariate analysis suggests that The metastatic rate of lymph node with longitudinal diameter 鈮，

本文编号：2232528