弹性成像对乳腺癌腋窝淋巴结的诊断价值

The diagnostic value of elastography in Axillary lymph node of breast cancer patients

目的本研究旨在探讨弹性成像在诊断乳腺癌患者腋窝淋巴结的诊断价值。方法收集2015年4月至2017年12月本院甲乳外科140例乳腺癌伴有腋窝淋巴结肿大的患者,记录淋巴结的纵径、纵横比、皮质厚度,淋巴门的位置和血流方式。所有患者行超声弹性成像,把淋巴结内硬度区域面积≥50%设为阳性。对照组织病理学结果进行分析,对常规二维超声、弹性成像、及常规超声联合弹性成像进行对比、分析和统计学处理。结果常规二维超声敏感性、特异性、准确性、阳性值分别为77.08%、87.10%、81.43%、88.24%;弹性成像敏感性,特异性、准确性、阳性值分别为60.16%、96.74%、76.43%、95.92%。常规二维超声联合弹性成像敏感性,特异性、准确性、阳性值分别为51.56%,100%、74.37%、100%。结论常规二维超声联合弹性成像用于诊断腋窝淋巴结状态的时候可以提高特异性。尽管敏感性较低,但常规二维超声和弹性成像的联合组合可以大幅度提高阳性预测值。对于乳腺癌患者的腋窝淋巴结术前评估,弹性成像是除了常规超声以外的又一种术前评估乳腺癌腋窝淋巴结有效的诊断方法。

Objective Explore the diagnostic value of elastography in Axillary lymph node of breast cancer patients.Methods 140 cases of breast cancer patients with axillary lymph node enlargement,hospitalized in department of thyroid and breast surgery of our hospital during April 2015 and December 2017,were enrolled in this study.The feature of axillary lymph nodes: longitudinal diameter,longitudinal-to-transverse diameter ratio,cortical thickness,location of the lymphatic hilum,and vascular pattern were recorded.All of them underwent elastography.The lymph node was defined as positive on elastography when the proportion of hard area was 50% or greater.We analyzed the results in contrast with the pathological examination results.The results of conventional two-dimensional US,elastography,and conjunctive combination of conventional two-dimensional US and elastography were compared, analyzed and statistical processed.Results The sensitivity, specificity,accuracy,positive predictive value were 77.08%,87.10%,81.43%,88.24%,respectively,for conventional two-dimensional US and 60.16%,96.74%,76.43%,95.92% for the elastography and 51.56%,100%,74.37%,100% for the conjunctive combination of conventional two-dimensional US and elastography.Conclusions Combination application of conventional two-dimensional US and elastography could improve specificity.Despite the low sensitivity,the combination of conventional two-dimensional US and elastography could improve the positive predictive value on a large scale.Elastography is a useful diagnostic tool in addition to conventional twodimensional US for the preoperative assessment of axillary lymph nodes in patients with breast cancer.