高频彩色多普勒超声及弹性成像在乳腺癌腋淋巴结转移中的应用价值

The application value of high frequency color doppler and ultrasonic elastography in axillary lymph node metastasis of breast cancer

目的探讨二维超声基础上应用高频彩色多普勒超声（2D-US）及弹性成像技术（UE）在评估乳腺癌腋淋巴结转移中的应用价值。方法回顾性收集2013年1月至2014年12月于我院乳腺外科住院并进行手术治疗,资料完整的乳腺癌患者120例,观察经病理证实的146枚乳腺癌患者的腋淋巴结,术前均行2D-US及UE检查,并以术后病理结果为金标准,比较分析2D-US、UE及二者结合对乳腺癌腋淋巴结转移的诊断价值。结果2D-US转移性淋巴结多表现为淋巴结长短轴比L/S〈2;皮质增厚≥3mm,低回声;血流类型多为周边型或混合型血流;血流程度为Adler 2~3级,与非转移性淋巴结组比较差异均存在统计学意义（P〈0.01）。UE显示转移性与非转移性淋巴结弹性评分比较差异有统计学意义（P〈0.01）,转移性评分多为3~4分,非转移性评分多为1~2分。2D-US、UE及二者联合应用诊断乳腺癌腋淋巴结转移的敏感度分别为79%,84%,92%;特异度分别为65%,72%,91%;准确率分别为73%,79%,92%。2D-US与UE诊断的敏感度及特异度差异无统计学意义（均P〉0.05）,而二者联合诊断的敏感度及特异度均高于二者单独使用,差异有统计学意义（均P〈0.05）。结论2D-US联合UE技术能够提高乳腺癌腋淋巴结转移的鉴别诊断效能,可为临床正确评估乳腺癌腋淋巴结情况提供一条新的途径。

Objective To explore the value of high frequency color Doppler（2D-US）and ultrasonic elastography（UE）in the diagnosis of axillary lymph node metastasis of breast cancer.Methods One hundred and twenty patients with breast cancer were selected retrospectively,who were hospitalized in our hospital breast surgery and underwent surgery.To observe 146 axillary lymph nodes confirmed by pathology,2D-US and UE were performed on each patient.With postoperative pathologic results as the gold standard,we compare and analyze the value of2D-US,UE and the combined use in the diagnosis of axillary lymph node metastasis of breast cancer.Results 2DUS displayed that more metastatic axillary lymph nodes were in the aspect ratio L/S〈2;cortical thickness≥3mm or low echo;Blood type was peripheral or mixed blood flow;degrees of blood flow were Adler 2-3level.Compared with the non-metastatic lymph node group,there were statistically significant differences（P〈0.01）.UE displayed that there was significant difference between the metastatic lymph nodes group and the non-metastatic lymph nodes group（P〈0.01）.Most score in was 3-4in the metastatic group and 1-2in the non-metastatic group.The sensitivity of 2D-US,UE and the combined use in the diagnosis of axillary lymph node metastasis of breast cancer were 79%,83%and 92%respectively;the specificity were 65%,72%and 91%respectively;the accuracy were 73%,79% and 92% respectively.The sensitivity and specificity of diagnosis had no obvious differences between 2D-US and UE（all P〉0.05）,and both the sensitivity and specificity of the combined use in diagnosis were higher than those of 2D-US and UE used alone,respectively.The differences were statistically significant（all P〈0.05）.Conclusion High frequency color doppler and ultrasonic elastography can increase the efficiency of the differential diagnosis of axillary lymph node metastasis of breast cancer and provide a new way of assessing the status of axillary lymph nodes of breast cancer properly.