超声引导细针穿刺对乳腺癌腋下淋巴结转移的诊断价值  

The study of ultrasound guided fine needle aspiration of axillary lymph nodes in breast cancer

作　　者：周世崇[1] 乐坚[1] 胡娜[1] 高毅[1] 常才[1] 

机构地区：[1]复旦大学附属肿瘤医院超声科 复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华超声影像学杂志》2017年第6期527-530,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81371575,81627804）

摘　　要：目的研究超声引导细针穿刺（FNA）对乳腺癌腋下转移淋巴结的诊断价值，并且与常规超声对乳腺癌转移淋巴结的诊断价值对比。方法前瞻性入组于我院手术，术前超声诊断肿瘤BIRADS分类4类或5类，肿瘤最大径线≤2cm，术前相关检查未发现远处转移的乳腺疾病患者500例。每例均行常规超声腋下检查，同时行超声引导FNA后细胞学检查，以最终病理结果为标准，比较两种方法的诊断效能。结果常规超声诊断的敏感度为60．6％，特异度为67．6％，阳性预测值为77．2％，阴性预测值为48．7％，准确度为63．1％。超声引导FNA诊断乳腺癌腋下淋巴结的敏感度为78％，特异度为100％，阳性预测值为100％，阴性预测值为71．6％，准确度为85．6％。两种诊断方法比较，差异具有统计学意义（χ^2=113．2，P〈0.001）。结论超声引导FNA可以有效减少前哨淋巴结活检的数量，具有一定的临床价值。Objective To study the value of ultrasound-guided fine needle aspiration （FNA） in the diagnosis of axillary lymph node metastasis in breast cancer, and to compared with conventional ultrasound in the diagnosis of metastatic lymph nodes of breast cancer. Methods Five hundred patients were enrolled into study prospectively from our hospital. The set of standard for patients into study： patients were diagnosed by BI-RADS and classified into class 4 or class 5 preoperative, the maximum diameter of the tumor was less than 2 cm, and there was no case of distant metastasis. Ultrasound guided FNA was performed in each case, and the results were compared with conventional ultrasound diagnosis results, using pathological findings as gold standard. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy in the diagnosis of axillary lymph node by conventional ultrasound were 60.6 %, 67.6 %, 77.2 %,48.7 %, and 63.1%, respectively, and by ultrasound-guided FNA were 78 %, 100%, 100%, 71.6%, and 85.6%, respectively. There were significant differences between the two diagnostic methods statistically （χ^2 = 113.2, P 〈 0.001 ）, Conclusions Ultrasound-guided FNA can effectively reduce the number of sentinel lymph node biopsy, which displays a certain clinical value.

关 键 词：超声检查 乳腺肿瘤 淋巴转移 活组织检查 细针 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]