B超判断乳腺癌腋窝淋巴结转移状态的临床研究  

Assessment of metastases status of axillary lymph nodes of breast disease patients' under ultrasound examination

作　　者：胡鹏遥[1] 尉承泽[1] 郝晓鹏[1] 柳伟伟[2] 白玲[1] 唐瑛[1] 陈子安[1] 陈雪梅[1] 宋聪睿 

机构地区：[1]军事医学科学院附属医院,北京100071 [2]军事医学科学院科技部统计学教研室,北京100850

出　　处：《军事医学》2015年第9期702-706,716,共6页Military Medical Sciences

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％（P＜0．001）；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％（P＜0．001）；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％（P＜0．001）；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％（P＜0．001）。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�Objective To assess the clinical application value of axillary lymph node staging of breast cancer by B ultrasound.Methods From February to December 2014, 200 female breast disease patients in Department of Breast Surgery Affiliated Hospital of Academy of Military Medical Sciences, were enrolled, with median age 50 years old, including 153 cases of breast cancer, 44 cases of fibroadenoma, 2 cases of mastitis and a case of huge fibroma.The state of axillary lymph node was assessed by doctor with more than twenty years experience in B ultrasound diagnosis.According to the characteristics of the ultrasound image of lymph node and experience of the B ultrasound doctor, the patients were divided into axillary lymph node metastasis group, suspicious group and no metastasis group.The axillary lymph nodes were staged by sentinel lymph node biopsy or axillary lymph node dissection.Based on pathological diagnosis and results of the ultrasound, the sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, and metastasis burden of axillary lymph nodes in false negative patients were analyzed.The relationship between the B ultrasound characteristics and axillary lymph node metastasis was also studied by univariate analysis.Results The metastasis rate of above-mentioned 3 groups by B ultrasound was 84.51%, 45.16% and 7.14%, respectively.The sensitivity,＆amp;nbsp;specificity, positive predictive value and negative predictive value of screening for axillary lymph node metastasis by B ultrasound were 89.6%, 89.1%, 84.5% and 92.7%, respectively in metastasis group and no metastasis group. According to consistency analysis between pathological diagnosis and B ultrasound, the Kappa value was 0.779.The false negative rate was only 7.1%（7/98 cases） in no metastasis group judged by B ultrasound, and the patients′axillary lymph node metastasis burden was very low, with only one lymph node positive.The univariate analysis showed that patients with longitudinal diameter of lymph nodes≥1

关 键 词：B超 乳腺癌 腋窝淋巴结 前哨淋巴结 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]