【摘要】：目的探討B(tài)超判斷乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移狀態(tài)的臨床應(yīng)用價(jià)值。方法納入2014年2~12月軍事醫(yī)學(xué)科學(xué)院附屬醫(yī)院乳腺外科200例女性初治乳腺疾病患者,中位年齡50歲。其中乳腺癌患者153例,乳腺炎患者2例,巨大纖維瘤1例,纖維腺瘤44例。良性乳腺疾患腋窩淋巴結(jié)不作處理;乳腺癌患者腋窩淋巴結(jié)行前哨淋巴結(jié)活檢,轉(zhuǎn)移陽性或臨床可疑時(shí)行腋窩淋巴結(jié)清掃。所有淋巴結(jié)均行石蠟病理檢查。由具有20年以上B超檢查經(jīng)驗(yàn)的醫(yī)師在不明原發(fā)病診斷情況下評估腋窩淋巴結(jié)轉(zhuǎn)移狀態(tài)。根據(jù)淋巴結(jié)B超影像學(xué)特征結(jié)合B超醫(yī)師經(jīng)驗(yàn),將患者分為腋窩淋巴結(jié)轉(zhuǎn)移組、可疑組和未轉(zhuǎn)移組。對照術(shù)后病理診斷結(jié)果,分析B超判斷腋窩淋巴結(jié)轉(zhuǎn)移的靈敏度、特異度、陽性及陰性預(yù)測值、假陰性率及假陰性患者腋窩淋巴結(jié)腫瘤轉(zhuǎn)移負(fù)荷,并對B超各參數(shù)在判斷腋窩淋巴結(jié)轉(zhuǎn)移的作用進(jìn)行單因素分析。結(jié)果 B超判斷上述3組的轉(zhuǎn)移率分別為84.51%、45.16%和7.14%;轉(zhuǎn)移組+未轉(zhuǎn)移組B超判斷腋窩淋巴結(jié)的轉(zhuǎn)移的靈敏度、特異度、陽性及陰性預(yù)測值分別為89.6%、89.1%、84.5%和92.7%;轉(zhuǎn)移組+未轉(zhuǎn)移組B超判斷腋窩淋巴結(jié)轉(zhuǎn)移與病理診斷結(jié)果的一致性分析顯示,Kappa值為0.779;7例B超判斷假陰性患者,腋窩淋巴結(jié)轉(zhuǎn)移負(fù)荷均只有1枚。單因素分析提示,淋巴結(jié)縱徑≥1 cm,其轉(zhuǎn)移率明顯高于縱徑1 cm,分別為44.2%/14.3%(P0.001);淋巴結(jié)縱橫比≤1.5的淋巴結(jié)轉(zhuǎn)移率顯著高于縱橫比1.5,為65.6%/35.1%(P0.001);淋巴結(jié)皮質(zhì)厚度≥3 mm的轉(zhuǎn)移率達(dá)67.5%,3 mm的淋巴結(jié)轉(zhuǎn)移率僅為1.2%(P0.001);淋巴結(jié)出現(xiàn)中央型或混合型血流信號,淋巴結(jié)轉(zhuǎn)移率分別達(dá)75%及79%(P0.001)。結(jié)論 B超可準(zhǔn)確判斷部分患者腋窩淋巴結(jié)轉(zhuǎn)移狀態(tài);假陰性患者腋窩淋巴結(jié)轉(zhuǎn)移負(fù)荷較低;縱徑≥1 cm、縱橫比≤1.5、皮質(zhì)厚度≥3 mm及出現(xiàn)中央型或混合型血流信號與淋巴結(jié)轉(zhuǎn)移相關(guān)。對于早期乳腺癌,B超可能是潛在的替代前哨腋窩淋巴結(jié)活檢進(jìn)行腋窩淋巴結(jié)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，

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