剪切波弹性技术预测乳腺癌腋下淋巴结转移状态的能力  

Ability of shear wave elastography to predict axillary lymph node metastasis

作　　者：臧丽[1] 李晶[1] 马燕[1] 

机构地区：[1]中国医科大学附属盛京医院超声科,沈阳110004

出　　处：《临床与病理杂志》2017年第12期2618-2624,共7页Journal of Clinical and Pathological Research

摘　　要：目的:探讨剪切波弹性成像技术(shear wave elastography,SWE)定量测量乳腺癌的硬度与腋下淋巴结转移(axillary lymph node metastasis,ALNM)状态的相关性,评估乳腺肿物的硬度信息预测ALNM的能力。方法:连续纳入370例经剪切波弹性定量测量并获得术后病理证实的乳腺癌患者作为研究对象,利用Q-box trace不规则描记方法获取肿物弹性的定量参数,将纵、横两个切面的平均硬度、最大硬度及标准差(standard deviation,SD)的平均值作为硬度平均值(Emean)、硬度最大值(Ema x)和SD。用单变量和多变量回归分析评估A L N M与肿物硬度值、肿物大小、肿物位置、患者年龄、组织学分级、肿瘤类型、ER表达、PR表达及HER-2状态之间的关系。结果:在单变量分析中,肿物大小、肿物位置、免疫组织化学和肿物硬度信息与淋巴结转移有显著的关联。在多因素分析中,肿物大小、肿物位置、HER-2、肿物硬度最大值和SD对预测淋巴结状态具有独立意义。淋巴结转移率随着硬度平均值和硬度最大值的增大而增大。结论:SWE定量测量乳腺癌硬度信息是预测ALNM的独立因素,可为术前淋巴结状态的评估、手术方式的选择以及患者预后提供重要的信息。Objective： To discuss the correlation between quantitative shear wave elastography （SWE） and axillary lymph node metastasis and evaluate the ability of shear wave elastography to predict axillary lymph node metastasis. Methods： Data were prospectively analyzed from 370 consecutive patients with invasive breast cancer who had undergone SWE examination and treated by primary surgery. Four elastography images—in each of two orthogonal planes—were taken of each lesion using the Aixplorer ultrasound system （SuperSonic Imagine, Aix en Provence, France）. Quantitative measurements were produced and analyzed by Q-box trace. Take the average number of two orthogonal planes as Emean, Emax and standard deviation （SD）. Associations between lymph node involvement and mean lesion stiffness, invasive cancer size, tumour location, histologic grade, tumour type, ER expression, PR expression, and HER-2 status were assessed using univariate and multivariate logistic regression. Results： At univariate analysis, invasive cancer size, tumour location, immunohistochemical profile, and stiffness value were significantly associated with nodal involvement. At multivariate analysis, invasive size, tumour location, HER-2, max stiffness and SD maintained independent significance. Nodal involvement rates increased with the Emax, Emean and SD. Conclusion： Stiffness at SWE is an independent predictor of lymph node metastasis and thus can confer prognostic information additional to that provided by preoperative tumour and lymph node assessment and staging.

关 键 词：乳腺癌 剪切波弹性成像技术 腋下淋巴结转移 硬度 

分 类 号：R737.9[医药卫生—肿瘤]