增强CT对乳腺癌腋窝淋巴结术前评估的价值  

Preoperative assessment value of enhanced CT for axillary lymph node in breast cancer

作　　者：高洋[1] 张文海[1] 李建一[1] 张扬[1] 贾实[1] 

机构地区：[1]中国医科大学附属盛京医院乳腺外科,沈阳110004

出　　处：《中华内分泌外科杂志》2013年第5期364-367,共4页Chinese Journal of Endocrine Surgery

基　　金：沈阳市社会发展攻关计划项目（1091142-9-02）

摘　　要：目的 研究增强CT对乳腺癌腋窝淋巴结评估的价值.方法 选择中国医科大学附属盛京医院乳腺外科近2年71例已病理证实第三站淋巴结（LevelⅢ）有转移的女性乳腺癌患者.采用Siemens64排CT,扫描范围自颈部至乳房下缘.分析增强CT影像：有无腋窝淋巴结肿大；肿大淋巴结的大小、形态、有无强化；通过测定CT净增强值,探索转移淋巴结的CT征象.分别总结归纳增强CT及乳房彩超对腋窝淋巴结的诊断指标；对LevelⅢ淋巴结的大小及CT净增强值进行平均值分析；分析LevelⅢ淋巴结转移与肿瘤的位置相关性.结果 对腋窝淋巴结诊断的准确度、敏感度、特异度、阳性预测值,三维彩超分别是70.4％、85.7％、64.0％、50.0％,增强CT分别是88.7％、90.6％、83.3％、94.1％；增强CT对LevelⅢ淋巴结诊断的准确度、敏感度、特异度及阳性预测值分别是95.8％、90.5％、98.0％、95.0％,同时计算出转移的LevelⅢ淋巴结长径＞（8.7±1.3）mm,短径＞（5.3±0.5）mm,CT净增强值＞（50.0±9.0） HU,且形态大部分以圆形或椭圆形的实心淋巴结为主.结论 增强CT对LevelⅢ淋巴结的正确诊断率明显高于三维彩超,LevelⅢ淋巴结的转移与肿瘤的位置没有相关性.Objective To study the assessment value of enhanced CT for axillary lymph node in breast cancer.Methods 71 patients meeting the inclusion criteria in our hospital were reviewed.They had level Ⅲ lymph nodes pathologically confirmed for almost 2 years.CT scan by a 64-detector row scanner were performed from the lower edge of breast to neck.CT images were analyzed from these aspects：with or without lymph node enlargement; the size and shape of the lymph nodes; lymph node with or without enhancement.Through the determination of CT net increase value,the metastasizing lymph node signs were explored.Diagnostic index of axillary lymph nodes imaged by breast sonography and enhanced CT were calculated separately.The size of level Ⅲ lymph node and CT net increase value were statistically analyzed.The correlation of metastasizing level Ⅲ lymph node and tumor location was analyzed.Results The accuracy,sensitivity,specificity,and positive predictive value of diagnosed axillary lymph node was 70.4％,85.7％,64.0％,and 50.0％ by three-dimensional ultrasound and 88.7％,90.6％,83.3％,and 94.1％ by enhanced CT.The accuracy,sensitivity,specificity,and positive predictive value of diagnosed level Ⅲ lymph node was 95.8％,90.5％,98.0％,and 95.0％ by enhanced CT.The maximal diameter of level Ⅲ lymph node was ＞ （8.7 ± 1.3） mm and the short diameter was ＞ （5.3 ±0.5） mm.CT net increase value was ＞ （50.0 ±9.0） HU.The shape of lymph nodes was mainly round or oval solid.Conclusions The diagnosis rate for level Ⅲ lymph node is obviously higher by enhanced CT than by three-dimensional ultrasound.There is no obvious correlation between level Ⅲ lymph node and tumor location.

关 键 词：乳腺癌 腋窝淋巴结 增强CT 

分 类 号：R737.9[医药卫生—肿瘤]