超声造影在乳腺癌患者腋淋巴结诊断中的价值

The Value of Contrast-enhanced Ultrasonography in Diagnosis of Axillary Lymph Nodes in Breast Cancer

目的:研究良恶性腋淋巴结的超声造影特征,并评价超声造影在乳腺癌患者术前腋淋巴结诊断中的价值。方法:回顾性分析65个良恶性腋淋巴结的超声造影增强征象和时间-强度曲线定量参数(AT、TTP、PI),比较超声造影和常规超声对良恶性腋淋巴结的诊断率。结果:65个腋淋巴结造影增强模式表现为:Ⅰ型整体增强型,Ⅱ型周边增强型,Ⅲ型局部增强型。造影增强模式在良恶性组中具有显著性差异(P<0.05),恶性多表现为整体增强型,良性多表现为周边增强型。以造影增强Ⅰ型为恶性诊断标准,Ⅱ型及Ⅲ型为良性诊断标准,则超声造影诊断良恶性腋淋巴结的敏感性、特异性、准确性分别为91.4%、73.3%、83.1%,而常规灰阶超声的诊断敏感性、特异性、准确性分别为68.6%、100%、83.1%。定量参数AT、TTP、PI在良恶性两组间无显著差异(P>0.05)。结论:超声造影对良恶性腋淋巴结鉴别诊断具有一定的价值,但与常规超声相比,超声造影并没有明显提高其诊断准确率。

Purpose： To evaluate the characteristics and value of contrast-enhanced ultrasonography （CEUS） in diagnosis of malignant and benign axillary lymph nodes of breast cancer. Methods： We retrospectively reviewed the contrast-enhanced sonographic signs of 65 malignant and benign axillary lymph nodes confirmed by histopathology, including enhanced pattems and quantitative parameters （AT, TTP, PI）, and the diagnostic accuracy between CEUS and conventional ultrasonography （US） was compared. Results： The contrast-enhanced sonographic appearance of 65 axillary lymph nodes could be summarized as the following three types： Type Ⅰ （global enhancement）, Type Ⅱ（peripheral enhancement）; Type Ⅲ （local enhancement）. When Type Ⅰ was regarded as the diagnostic criteria of benign lymph nodes, Type Ⅱ and Type Ⅲ were regarded as malignant lymph nodes, the sensitivity, specificity and accuracy of CEUS were 91.4%, 73.3% and 83.1%, that of conventional US were 68.6%, 100% and 83.1%. There were no significant differences in value of AT, TTP, PI between benign and malignant axillary lymph nodes （P〉0.05）. Conelusion： CEUS has a certain value in diagnosis of malignant and benign axillary lymph nodes of breast cancer, but it doesn＇t further improve the diagnostic accuracy when comparing to conventional US.