超声多参数预测腺癌腋窝淋巴结转移的意义

Ultrasonographic application in predicting axillary lymph nodes metastasis in patients with breast cancer

目的探讨乳腺癌患者乳腺肿块及腋窝淋巴结的声像图特征与腋窝淋巴结转移的相关性。方法采用彩色多普勒超声仪，对108例乳腺癌患者乳腺肿块及腋窝淋巴结进行超声检查，记录患者年龄、病灶患侧、病灶象限、病灶数目、病灶最大径、病灶纵横比、边界、内部回声、微钙化、血流分级、肿块内彩色像素百分比（color pixel density，CPD）、最高血流速度、阻力指数、腋窝淋巴结纵横比、腋窝淋巴结皮质最大厚度共15项指标，应用Y。检验及Logistic回归进行统计分析。结果在108例患者中病灶纵横比〉1者75例（69．4％），微钙化57例（52．8％），病灶内血流分级Ⅱ～Ⅲ级57例（52．8％），CPD≥10％者48例（44．4％），淋巴结皮质最大厚度≥3mm者51例（47．2％），淋巴结纵横比〈1．5者59例（54．6％）。单因素分析结果显示以上6项参数为腋窝淋巴结转移相关因素（Pd0．05），而患者年龄、病灶患侧、病灶象限、病灶数目、病灶最大径、边界、回声分布、最高血流速、阻力指数等9项参数与乳腺癌腋窝淋巴结转移无相关性（P〉O．05）。多因素回归分析结果显示CPD、淋巴结纵横比及微钙化为腋窝淋巴结转移危险因素，其0R值分别为16．337、3．754、3．033，95％C1分别为4．537—58．826、1．269—11．108、1．040—8．840。结论乳腺癌患者乳腺肿块及腋窝淋巴结的超声声像图部分参数预测乳腺癌腋窝淋巴结转移有较高的临床价值。

Objective To evaluate the implication of ultrasonographic features of primary breast cancer tumors and axillary lymph nodes in predicting axillary lymph nodes metastasis in patients with breast cancer. Methods A total of 108 patients with breast cancer were underwent examination of primary breast tumors and axillary lymph nodes by high frequency linear-array probes of ultrasound. The ages of patients, locations of primary tumors, numbers of tumors, maximum diameters of tumors, the longitudinal transverse axis ratio of tumors, mass boundary, ultrasonic patterns, micro-calcification, classification of blood supply, color pixel density（CPD）, peak systolic velocity, resistance index, the longitudinal transverse axis ratio of axillary lymph nodes and maximum cortical thickness of axillary lymph nodes were recorded. Results Out of 108 patients with breast cancer,the longitudinal transverse axis ratio of tumor were greater than 1 in 75 （69.4% ）, micro-calcification in 57（52.8% ）, classification of blood supply were II - III in 57 （52.8 % ）, CPD were greater than or equal to 10% in 48 （44.4%）,maximum cortical thickness of axillary lymph node were greater than or equal to 3 mm in 51 （47.2%）,and longitudinal transverse axis ratio of lymph nodes were less than 1.5 in 59 （54.6%）. Univariate analysis revealed that these six parameters were correlated to the axillary lymph node metastasis in breast cancer （ P 〈0.05）. However,ages of patients, location of tumor in the breast, numbers of tumors, maximum diameters of tumors, mass boundary, ultrasonic patterns, peak systolic velocity and resistance index were not related to the axillary lymph node metastasis（ P 〉0.05）. Multivariate logistic regression analyses showed that CPD （OR： 16. 337, 95% CI： 4. 537 - 58. 826）, longitudinal transverse axis ratio of lymph nodes （OR.. 3. 754, 95% CI：1.269- 11. 108） and microcalcificationand （OR..3. 033,95 % CI：1. 040 - 8. 840） were risk factors of axillary lymph nodes metastasis in patients with breast lancer. Conclusions The application of ultrasonography in patients with breast cancer is useful in predicting axillary lymph nodes metastasis.