超声与钼靶及二者联合检查对乳腺癌淋巴结转移的诊断价值

Comparison of Sonography,Mammography and Combination of Both in Detecting of Lymph Node Metastasis for Patients with Breast Cancer

[目的]比较B超、钼靶及二者联合检查对乳腺癌淋巴结显像的能力。[方法]收集武汉大学人民医院经病理证实的乳腺癌患者共118例,比较B超、钼靶及二者联合检查对淋巴结显像的灵敏度、特异性、误诊率、漏诊率、阳性预测值、阴性预测值及总符合率。[结果]超声检查的灵敏度为47.4%,特异性为73.7%,误诊率为26.3%,漏诊率为52.6%,阳性预测值为54.5%,阴性预测值为67.7%,总符合率为63.2%。钼靶检查的灵敏度为88.2%,特异性为24.0%,误诊率为76.0%,漏诊率为11.8%,阳性预测值为61.2%,阴性预测值为60.0%,总符合率为61.0%。二者联合检查的灵敏度为91.3%,特异性为15.4%,误诊率为84.6%,漏诊率为8.7%,阳性预测值为65.6%,阴性预测值为50.0%,总符合率为63.9%。超声检查结果与病理结果的一致性较弱(κ=0.215,P=0.035)。以淋巴结转移数目分层,3种方法的检出水平与转移数目无关。[结论]超声在术前诊断乳腺癌淋巴结转移方面优于钼靶、以及超声和钼靶联合检查。此外,乳腺癌淋巴结转移的影像学检出水平与淋巴结转移数目无关。

[Purpose ] To evaluate the efficacy of sonography,mammography and combination of both in detecting lymph node metastasis for patients with breast cancer. [ Methods ] A total of 118 patients with breast cancer pathology proven were enrolled. The perfomlances of ultrasound and mammography on lymph nodes imaging were compared. [Results ] The sensitivity, specificity, mis diagnostic rate ,missed diagnostic rate ,positive predictive value ,negative predictive value ,overall diagnostic accordance rate of sonography were 47.4% ,73.7% ,26.3% ,52.6% ,54.5% ,67.7%, 63.2%, respectively. Those with mammography were 88.2%, 24.0%, 76.0%, 11.8%, 61.2%, 60.0%, 61.0%, and of combination of both were 91.3%, 15.4%, 84.6%, 8.7%, 65.6%, 50.0%, 63.9%. Sonography was in weak accordance with pathology （kappa value was 0.215）. There was no corre lation between the number of lymph nodes metastasis and the level of detection ability. [Conclu sion] Ultrasound is better than mammography and combination of sonography and mammography on detecting lymph nodes metastasis in patients with breast cancer. No association exists between the number of lymph nodes metastasis and the imaging result.