腋淋巴结超声分级在术前穿刺活检中的选择作用  

Role of preoperative sonographic classifcation of axillary lymph nodes in selection of the core biopsy nodes in breast carcinoma

作　　者：李大强[1] 李燕[1] 

机构地区：[1]徐州市肿瘤医院超声科,江苏徐州221005

出　　处：《徐州医学院学报》2012年第3期176-179,共4页Acta Academiae Medicinae Xuzhou

基　　金：徐州市科技计划项目（XM0913099）

摘　　要：目的 探讨腋淋巴结超声分级对乳腺癌患者术前待穿刺淋巴结的选择作用.方法 原发性乳腺癌179例,术前1周内进行腋淋巴结超声检查.根据淋巴结皮质厚度及有无结门高回声将其分为5级.选择皮质最厚、离乳腺原发病灶最近的淋巴结进行超声引导穿刺活检并用注射亚甲蓝方式术前定位此淋巴结,术后送常规病理检查.以术后病理检查为金标准,分析超声分级的各级恶性淋巴结发生率及超声分级判断腋淋巴结转移的敏感度、特异度及准确度.结果 179例乳腺癌腋淋巴结超声分级为：1级40例,2级80例,3级40例,4级10例,5级9例.腋淋巴结穿刺活检的179个淋巴结中42个（23.5%）有转移,137个（76.5%）无转移;术后病理证实54例腋淋巴结有转移.各超声分级穿刺淋巴结转移发生率分别为：1级5%（2/40）,2级9%（7/80）,3级40%（16/40）,4级80%（8/10）,5级100%（9/9）.以淋巴结皮质厚度大于2.5 mm为截点,超声分级判断腋淋巴结转移的敏感度为78.6%（33/42）,特异度为81.2%（111/137）.结论 基于淋巴结皮质厚度及结门回声改变的超声分级可于术前有效预测乳腺癌腋淋巴结转移.当超声发现腋淋巴结皮质厚度大于2.5 mm时,应该进一步进行超声引导下的淋巴结穿刺活检术以确认淋巴结有无转移.Objecttive To prospectively evaluate the role of sonographic axillary lymph node classification to select the core biopsy nodes in breast cancer patients by node - to - node correlation with surgical histopathology resuhs. Meth- ods Preoperative axillary sonography was performed in 179 consecutive breast cancer patients who had been scheduled to undergo breast cancer surgery. The axillary lymph node that had the thickest cortex or that was closest to the primary tumor was prospectively classifed and then US - guided core biopsy was performed. Biopsy results were compared to the axillary dissection results. Sensitivity, specificity and accuracy of the core biopsy in the detection of malignancy were cal- culated. The rate of malignancy, according to the sonographic classifcation, was analyzed. Results Of the 179 nodes, 42 （23.5%） had metastases and 137（76.5% ） did not have metastases. When a cutoff point of a cortical thickness of 2.5 mm was used, sonographie classifcation showed 78.6% （33/42） sensitivity, 81.2% （ 111/137 ） specificity. Of the 54 patients with metastases at axillary lymph node dissection, 12 （22%） had false -negative results of sonographically guided core biopsy. Nodes with a cortical thickness of more than 2.5 mm were considered as suspicious metastases lymph nodes and should to be biopsy. Conclusion Sonographic classifcation of axillary lymph nodes is effective for predicting the presence of metastases and is a reliable method to select the biopsy node.

关 键 词：乳腺癌 腋淋巴结 转移 超声检查 超声引导穿刺活检 

分 类 号：R737.9[医药卫生—肿瘤]