超声引导腋窝淋巴结穿刺活检在诊断乳腺癌腋窝淋巴结转移中的临床价值研究  

Clinical value of ultrasound-guided core needle biopsy for detecting axillary lymph node metastasis in breast cancer

作　　者：赵一博[1] 白玲[2] 唐英[2] 柳伟伟[3] 郝晓鹏[1] 陈翠京[2] 尉承泽[1] 

机构地区：[1]军事医学科学院附属医院乳腺外科,北京100071 [2]军事医学科学院附属医院超声科,北京100071 [3]军事医学科学院研究生部统计学教研室,北京100850

出　　处：《军事医学》2015年第7期541-545,共5页Military Medical Sciences

摘　　要：目的探讨超声及超声引导下穿刺活检（UNB）在判断乳腺癌腋窝淋巴结转移中的临床应用价值。方法回顾分析2008年6月~2014年8月期间连续收治454例乳腺癌,超声判断腋窝淋巴结异常行UNB患者临床资料,其中354例行新辅助化疗;100例腋窝淋巴结UNB后行手术治疗,评价超声及UNB判断乳腺癌腋窝淋巴结转移的敏感性、特异性、准确性、阳性预测值、阴性预测值及假阴性率。结果 454例超声影像学腋窝淋巴结异常乳腺癌患者UNB转移率为70.9%,阴性率为29.1%;100例腋窝淋巴结UNB后行手术治疗患者转移率为25%;13例淋巴结纵横径比值（L/T）≤1.5且淋巴结纵径〉1 cm患者转移率为92.3%;UNB判断乳腺癌腋窝淋巴结转移的敏感性为64.1%、特异性为100%、准确性为86%、阳性预测值为100%、阴性预测值为81.3%、假阴性率为18.7%;UNB判断结果与术后病理诊断结果的一致性较好,Kappa值为0.685;其中UNB取材2针与3针的上述6项指标分别为50%与77.8%、100%与100%、77.8%与92.5%、100%与100%、71.4%与89.7%、28.6%与10.3%,UNB取材3针相比2针与术后病理一致性分析显示,Kappa值为0.822/0.526。结论超声判断乳腺癌腋窝淋巴结转移具有一定的临床价值;UNB可准确判断腋窝淋巴结转移状态;UNB取材3针相比2针有更高的准确性。Objective To analyze the clinical value of ultrasound and ultrasound-guided core needle biopsy（ UNB） in the evaluation of axillary lymph node metastasis for breast cancer. Methods A total of 454 cases of breast cancer treated between June 2008 and August 2014 at our hospital were retrospectively analyzed. UNB was performed on patients with abnormal ultrasonic diagnosis of axillary lymph nodes. Among them,354 cases underwent neoadjuvant chemotherapy or endocrine therapy while 100 cases underwent surgery after UNB. The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and false negative rate of ultrasound and UNB were evaluated. Results Among the 454 patients with abnormal axillary lymph nodes of ultrasound imaging,the metastasis rate with UNB was 70. 9%,while the negative rate was 29. 1%. Among the 100 cases who underwent surgery after UNB,the metastasis rate was 25% while the ultrasound imaging lymph node longitudinal and transversal（ L / T） ≤1. 5,the lymph node size 1 cm,and the metastasis rate was 92. 3%（ 12 /13）. UNB showed that sensitivity was 64. 1%,specificity 100%,accuracy 86%,positive predictive value 100%,negative predictive value 81. 3%,and false negative rate was 18. 7%. The results of UNB seemed consistent with those of postoperative pathological diagnosis,the Kappa value being 0. 685. Based on 2 and 3 needles,the above mentioned 6 indices were 50% and 77. 8%,100% and 100%,77. 8% and 92. 5%,100% and 100%,71. 4% and89. 7%,and 28. 6% and 10. 3%,respectively. The Kappa value of UNB based on 3 needles was higher than on 2 needles（ 0. 822 vs 0. 526）. Conclusion Ultrasound is a valuable tool for detecting axillary lymph node metastasis in breast cancer. UNB can accurately determine the axillary lymph node metastasis status. UNB based on 3 needles shows a higher accuracy than on 2 needles.

关 键 词：乳腺肿瘤 腋窝淋巴结 超声引导下空心针穿刺活检 肿瘤转移 

分 类 号：R737.9[医药卫生—肿瘤]