乳腺癌腋窝淋巴结转移的超声诊断价值及临床病理相关性分析

Analysis of detecting value of ultrasound and the clinic-pathological features of axillary metastasis in breast cancer

目的 回顾性研究超声检查对乳腺癌腋窝淋巴结转移的诊断价值;分析腋窝淋巴结转移乳腺癌的临床病理特征.方法 回顾性分析2012年6月至2013年6月收治的323例新发女性浸润性乳腺癌患者的临床资料,中位年龄54岁,全部接受腋窝淋巴结超声检查及病理检查.以组织病理学诊断为金标准分析超声检查对乳腺癌患者腋窝淋巴结转移的诊断价值,并依据2013年St.Gallen专家共识进行分子分型,利用χ^2检验探讨腋窝淋巴结转移乳腺癌的临床病理特点.结果 超声评价腋窝淋巴结转移灵敏度为35.6％ （46/129）,特异度为98.9％ （181/183）,阳性预测值为95.8％ （46/48）,阴性预测值为68.6％ （181/264）.入组患者Luminal A-like型11.2％（36/323）,Luminal B-like型58.5％（189/323）,人类表皮生长因子受体2过表达型13.3％（43/323）,三阴型17.0％（55/323）.单因素分析结果显示,腋窝淋巴结转移与月经状态、原发肿瘤T分期相关（χ^2=4.337、11.100,P=0.037、0.001）,与原发肿瘤分子分型无明显相关性.结论 超声检查对诊断腋窝淋巴结状态具有一定价值,前哨淋巴结活检是腋窝淋巴结临床分期的重要补充.乳腺癌腋窝淋巴结转移与月经状态、肿瘤T分期具有相关性,与分子分型无明显相关性.

Objectives To evaluate the value of ultrasound （US） in predicting axilla status and to investigate the clinic pathologic characters in the axillary node metastasis.Methods From June 2012 to June 2013,323 female primary breast cancer patients who received both axilla ultrasound and pathology examinations were reviewed retrospectively.The features of axillary nodes including diameter,longitudinaltransverse axis ratio,cortical thickness and blood flow grade were used to evaluate axillary status.US accuracy of axillary node metastasis was analyzed correlated with the final pathology results.The clinical and histological features associated with axillary node metastasis was analyzed by χ^2 test.Results The proportions of Luminal A-like,Luminal B-like,human epidermalgrowth factor receptor-2 positive and triple negative breast cancer were 11.1% （36/323）,58.5% （189/323）,13.3% （43/323） and 17.0% （55/ 323）.The sensitivity,specificity,positive predictive value and negative predictive value of axilla US in the diagnosis of nodal metastasis were 35.6% （46/129）,98.9% （181/183）,95.8% （46/48） and 68.6% （181/264）.Axillary lymph node metastasis had statistically significant correlation with menopausal status and clinical tumor size （χ^2 =4.337,11.100 ; P =0.037,0.001）.Conclusions Standardized ultrasound is the basic way to evaluate axilla status.Sentinel lymph node biopsy should be done to acquire accurate preoperative staging of axilla when US shows no signs of metastasis.Axillary lymph node metastasis is significantly related to menopausal status and clinical tumor size,but not significantly related to subtype classification of primary breast cancer.