超声弹性成像联合CDFI对乳腺癌患者腋窝肿大淋巴结的诊断价值

Application of ultrasound elastography combined with CDFI in the diagnosis of enlarged axillary lymph nodes in breast cancer patients

目的探讨超声弹性成像联合彩色多普勒血流显像（CDFI）用于评估乳腺癌患者腋窝淋巴结良恶性的临床价值。方法对58例患者126个同侧腋窝肿大淋巴结行超声弹性成像联合CDFI检查，以术后病理检查结果为标准，绘制受试者工作特征曲线（ROC曲线）并评价超声弹性成像联合CDFI对乳腺癌患者腋窝肿大淋巴结的诊断价值。结果超声弹性成像联合CDFI诊断转移性淋巴结71枚，非转移性淋巴结55枚。非转移性腋窝淋巴结血流以Ⅰ型为主，26例（47％）；转移性腋窝淋巴结血流以Ⅲ型为主，36例（51％）。转移性淋巴结弹性评分4分＋血流Ⅲ型30例，5分＋血流Ⅲ型6例；非转移性淋巴结弹性评分4分＋血流Ⅲ型5例，5分＋血流Ⅱ型1例，3分＋血流Ⅲ型6例，2分＋血流Ⅲ型1例。CDFI、超声弹性成像二者联合诊断腋窝淋巴结转移的ROC曲线下面积为0．9042，敏感度0．9824，特异度0．7503。结论超声弹性成像联合CDFI对乳腺癌腋窝转移性淋巴结具有较好的诊断价值。

Objective To discuss the application of ultrasound elastography combined with color Doppler flow imaging （CDFI） in the diagnosis of benign and malignant axillary lymph nodes. Methods A total of 58 breast cancer patients with 126 enlarged homolateral axillary lymph nodes were examined by ultrasound elastography combined with CDFI. Then, based on pathological results after surgery, a receiver operator characteristic curve （ROC） was plotted. The use of the combined model to diagnose enlarged axillary lymph nodes were also evaluated. Results According to the combined model, there were 71 metastatic lymph nodes and 55 non - metastatic lymph nodes. Type m blood flow was present in most of metastatic lymph nodes （36/71, 51% ）, while type Ⅰ blood flow in most of non -metastatic lymph nodes （26/ 55, 47% ）. There were 30 type Ⅲ blood flow patients with an elastic score of metastatic lymph nodes of 4; and 6 type Ⅲ blood flow patients with an elastic score of 5. There were 5 type m blood flow patients with an elastic score of non - metastatic lymph nodes of 4 ; 1 type Ⅱ blood flow patient with an elastic score of 5 ; 6 type Ⅲ blood flow patients with an elastic score of 3 and 1 type Ⅲ blood flow patient with an elastic score of 2. The area under ROC curve （AUC） of ultrasound elastography combined with CDFI for diagnosis of metastatic axillary lymph nodes was 0.904 2, with a sensitivity of 0. 982 4 and a specificity of 0. 750 3. Conclusion The ultrasound elastography combined with CDFI is useful for diagnosis of metastatic axillary lymph nodes.