超声引导下空芯针穿刺活检对乳腺癌的诊断价值  

The application of ultrasound-guided core needle biopsy in the diagnosis of breast cancer

作　　者：杨丽[1] 朱荔 刘紫朦 鲍宝石 马金平 王建东[2] YANG LI;ZHU LI;LIU Zimeng(Department of General Surgery,Beijing Shumyi Hospital,Beijing 101300,China)

机构地区：[1]北京市顺义区医院普外二科,101300 [2]中国人民解放军总医院第一临床中心普通外科 [3]山东省烟台蓬莱市人民医院普通外科

出　　处：《临床外科杂志》2021年第3期231-234,共4页Journal of Clinical Surgery

摘　　要：目的分析乳腺癌病人超声引导下空芯针穿刺活检(USCNB)与术后病理诊断及免疫组化(IHC)一致性情况并分析其与肿物大小的关系,了解USCNB诊断腋窝淋巴结(ALN)转移状态的准确性。方法回顾性分析431例乳腺癌病人临床病理学资料,比较USCNB及术后病理结果,了解USCNB对乳腺癌的检出率及ALN转移诊断的准确性及其与术后病理免疫组化(ER、PR、HER-2及Ki-67)诊断的一致性,分析乳腺肿物大小对乳腺癌检出率及免疫组化一致性的影响。结果 USCNB的乳腺癌检出率为96.75%(417/431),不同肿物大小组间检出率比较,差异无统计学意义(P>0.05);USCNB对异常ALN转移诊断的准确性为90.34%,敏感性88.50%,特异性96.88%,假阴性率11.50%,假阳性率3.13%,ROC曲线下面积(AUC) 0.846;USCNB与术后ER、PR、HER-2、Ki-67的一致率分别为92.11%、90.49%、89.33%、70.30%,Kappa值分别为0.780、0.752、0.743、0.290,ER、PR、HER-2的AUC值分别为0.719、0.700、0.479;ER、HER-2的一致性随着肿物的增大而降低(P <0.05),而PR与Ki-67一致性的差异无统计学意义(P> 0.05)。结论USCNB是乳腺癌及ALN分期可靠诊断方法,USCNB与术后的ER、PR一致性较好,且ER、HER-2诊断的一致性与肿物大小相关。Objective immunohistochemical results between specimens obtained by Ultrasound-guided core needle biopsy( USCNB) and postoperative in the breast cancer and to analyze the influence of tumor size on it. To understand the accuracy of USCNB in the diagnosis of axillary lymph node( ALN) metastasis. Methods Retrospectively analyzed the clinicopathological data of 431 patients with breast cancer. Compared the pathological results of USCNB with postoperative pathology to understand the detection rate of breast cancer and the accuracy of ALN metastasis diagnosis by USCNB and to understand the consistency of immunohistochemistry( ER,PR,HER-2 and Ki-67) between USCNB and postoperative pathology.Analyzed of the influence of breast tumor size on the detection rate and immunohistochemistry consistency of breast cancer. Results 417 cases were diagnosed of breast cancer by USCNB,the detection rate of breast cancer was 96. 75%. The analysis indicated that there was no significantly difference of the detection rates of USCNB for breast cancer among groups with different tumor size( P > 0. 05). For the pathological diagnosis of abnormal ALN by USCNB,the accuracy was 90. 34%( 131/145),the sensitivity was 88. 50%( 100/113),the specificity was 96. 88%( 31/32),the false negative rate was 11. 50%( 13/113),and the false positive rate was 3. 13%( 1/32). The diagnostic coincidence rates of ER,PR,HER-2 and Ki-67 were 92. 11%,90. 49%,89. 33% and 70. 30%. The Kappa values were 0. 780,0. 752,0. 743 and 0. 290,AUC values of ER,PR and HER-2 were 0. 719,0. 700 and 0. 479. The consistency between USCNB and ER,HER-2 decreased with the increase of tumor( P < 0. 05),but there was no significant difference in the coincidence rates of PR and Ki-67 among different tumor size groups( P > 0. 05).Conclusion USCNB is a reliable diagnostic method for breast cancer and ALN staging. The consistency of ER and PR between specimens obtained from USCNB and postoperative is good. The consistency of ER and HER-2 is related to the tumor size.

关 键 词：乳腺癌 超声引导下空芯针穿刺活检 免疫组化 一致性 腋窝淋巴结 

分 类 号：R737.9[医药卫生—肿瘤]