乳腺癌患者腋窝淋巴结转移的危险因素及行X线摄影与CT检查的诊断效能分析  

Risk Factors for Axillary Lymph Node Metastasis in Breast Cancer Patientsand Comparative Diagnostic Efficacy of X-ray Imaging and CT Scans

作　　者：王浩宇[1] 石文达[1] 赵晓彬 崔志新[1] WANG Haoyu;SHI Wenda;ZHAO Xiaobin(The Affiliated Hospital of Chengde Medical University,Hebei Chengde 067000,China)

机构地区：[1]承德医学院附属医院放射科,河北承德067000

出　　处：《河北医学》2024年第3期506-511,共6页Hebei Medicine

基　　金：河北省承德市科技计划自筹经费项目,(编号:202204A068)。

摘　　要：目的:探讨乳腺癌患者腋窝淋巴结转移的危险因素及X线与CT检查的诊断效能比较。方法:选取2021年1月至2023年5月在我院治疗的乳腺癌患者112例,分析发生和未发生腋窝淋巴结转移患者临床资料差异;同时分析X线、CT检查诊断腋窝淋巴结转移的价值。结果:112例患者中,腋窝淋巴结转移患者32例,腋窝淋巴结转移率为28.57%;发生腋窝淋巴结转移患者组织低分化比例、组织类型为浸润性癌比例、有脉管浸润比例、肿瘤直径≥5cm比例、组织Ki-67表达≥14%比例分别为68.75%、90.63%、28.13%、31.25%和84.38%,明显高于未发生腋窝淋巴结转移患者(P<0.05);Logistic回归分析显示:分化程度、病灶组织类型、脉管浸润、Ki-67表达是乳腺癌患者发生腋窝淋巴结转移的影响因素(P<0.05);X线诊断腋窝淋巴结转移与病理结果一致性Kappa值为0.500,P<0.05,一致性较差;CT诊断腋窝淋巴结转移与病理结果一致性Kappa值为0.825,P<0.05,一致性较好;CT诊断腋窝淋巴结转移的准确性、灵敏性和阴性预测值分别为92.86%、87.50%和95.00%,明显高于X线检查(P<0.05)。结论:乳腺癌患者腋窝淋巴结转移受分化程度、病灶组织类型、脉管浸润、Ki-67表达的影响;相较于X线,CT诊断腋窝淋巴结转移的价值较高。Objective:To explore the risk factors of axillary lymph node metastasis in breast cancer patients and compare the diagnostic efficacy of X-ray and CT examinations.Methods:A total of 112 breast cancer patients treated in our hospital from January 2021 to May 2023 were selected.Differences in clinical data between patients with and without axillary lymph node metastasis were analyzed.The diagnostic value of X-ray and CT examinations for axillary lymph node metastasis was also assessed.Results:Among the 112 patients,32 had axillary lymph node metastasis,lymph node metastasis rate was 28.57%.The proportion of patients with axillary lymph node metastasis with low differentiation,invasive cancer,vascular infiltration,tumor diameter≥5cm,and Ki-67 expression≥14%were 68.75%,90.63%,28.13%,31.25%,and 84.38%,respectively,which were significantly higher than those without axillary lymph node metastasis(P<0.05).Logistic regression analysis showed that differentiation degree,focus tissue type,vascular invasion,Ki-67 expression were the influencing factors of axillary lymph node metastasis in breast cancer patients(P<0.05).The consistency between X-ray diagnosis of axillary lymph node metastasis and pathological results was poor,with a Kappa value of 0.500 and P<0.05.The consistency between CT diagnosis of axillary lymph node metastasis and pathological results was good,with a Kappa value of 0.825 and P<0.05.The sensitivity,accuracy,and negative predictive values of CT in diagnosing axillary lymph node metastasis were 92.86%,87.50%,and 95.00%,respectively,which were significantly higher than those of X-ray examination(P<0.05).Conclusion:The occurrence of axillary lymph node metastasis in breast cancer patients is influenced by differentiation degree,lesion tissue type,vascular invasion,and Ki-67 expression.Compared to X-ray,CT demonstrates higher diagnostic value for axillary lymph node metastasis.

关 键 词：乳腺癌 腋窝淋巴结转移 危险因素 X线 CT检查 

分 类 号：R737.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]