腋窝淋巴结联合原发病灶超声诊断乳腺癌腋淋巴结转移的价值

The combination of axillary sonography and the echoic halo of breast lesion in the preoperative staging assessment of invasive breast cancer

目的 评价淋巴结超声形态征象结合乳腺原发肿块超声特征综合判断乳腺癌术前腋窝淋巴结状态的诊断价值.方法 超声观察95例乳腺癌患者原发灶和腋淋巴结.以腋淋巴结清扫的病理结果为金标准,对单独应用淋巴结超声征象（单独组）和联合应用淋巴结超声征象及乳腺原发灶声像（联合组）对腋窝淋巴结有无转移进行诊断价值评价.结果 在95例浸润性乳腺癌中,病理证实34例有腋淋巴结转移,61例腋淋巴结阴性.单独组和联合组诊断腋淋巴结转移的敏感度、特异度、阳性预测值和阴性预测值分别为52.9%、82.5%、66.7%和76.5%及76.5%、83.6%、72.2%和86.4%.两组敏感度比较,差异有统计学意义,联合诊断法明显提高诊断敏感度.结论 腋窝淋巴结超声诊断乳腺癌腋淋巴结转移具有中等度敏感性和较高特异性;联合乳腺原发肿块超声征象可明显提高敏感性.

Objective The aim of this study was to evaluate the diagnostic accuracy of axillary lymph node sono- graphic features combined with primary breast mass sonographic features in the preoperative evaluation of invasive breast cancer. Methods From March 2007 to January 2008, we evaluated 95 invasive breast cancer patients with ultrasound. We assessed lymph nodes for size, visibility of the hilum, focal cortical thickening, and ratio between hilar axis and longi- tudinal axis. The sonographic features of breast lesions assessed were size and the echoic halo around breast lesion. The di- agnostic accuracy of lymph node sonographic features only or combined with breast lesion features were calculated respec- tively. Results Of the 95 cases with invasive breast cancer, 34 had pathologically metastastic axillary nodes, while the other 61 were free of metastases in axilla. The sensitivity, specificity, positive predictive value, and negative predictive value of the axillary node sonographic features was 52.9 %, 82.5 %, 66.7 %, 76.5 %, respectively, and 76.5 %, 83.6 %, 72.2 %, 86.4 %, respectively, if combined with breast lesion features. The combined group was proved to have higher sensitivity than axillary node features group （x2 = 4. 12,P = O. 042）. Conclusion The sonographic axillary lymph node features had moderate sensitivity and fairly higher specificity in the diagnosis of axiUary nodes in invasive breast cancer. When it comes to use lymph node combined with breast lesion features, the sensitivity proved to be evidently higher than the former.