高频彩色多普勒超声早期诊断乳腺癌腋窝淋巴结转移的临床应用价值

Clinical application of high frequency color Doppler ultrasonography in the early diagnosis of axillary lymph node metastasis of breast cancer

目的探讨应用高频彩色多普勒超声早期诊断乳腺癌腋窝淋巴结转移的临床应用价值。方法选取拟实施乳腺癌根治手术的140例乳腺癌患者作为研究对象,所有患者术前均接受了乳腺及腋窝淋巴结高频彩色多普勒超声检查;选取其中77例经手术后病理学检查确诊为乳腺癌腋窝淋巴结转移的患者作为发生腋窝淋巴结转移组,余63例乳腺癌患者作为未发生腋窝淋巴结转移组。以术后病理学检查结果作为金标准,计算术前高频彩色多普勒超声诊断腋窝淋巴结转移的诊断学价值指标。结果发生腋窝淋巴结转移组的皮质向心性增厚、淋巴结长短径之比、淋巴结内钙化灶、淋巴结的边界不清检出率均明显高于未发生腋窝淋巴结转移组,差异均有统计学意义(P﹤0.01);发生腋窝淋巴结转移组患者与未发生腋窝淋巴结转移组患者的血流分布和血流信号分级情况比较,差异均有统计学意义(P﹤0.01)。其中,发生腋窝淋巴结转移组患者的血流分布主要以周边型为主(59.74%),血流信号分级主要为3级(71.43%);未发生腋窝淋巴结转移组患者的血流分布主要以门型为主(11.11%),血流信号分级主要为2级(71.43%);高频彩色多普勒超声早期诊断乳腺癌腋窝淋巴结转移的灵敏度为89.61%,特异度为82.54%,漏诊率为10.39%,误诊率为17.46%。结论高频彩色多普勒超声对早期诊断乳腺癌腋窝淋巴结转移具有较高的临床实用价值。

Objective To investigate the clinical value of high frequency color Doppler ultrasonography in the early diagnosis of axillary lymph node metastasis of breast cancer. Method 140 cases of breast cancer with elective surgery were examined with high frequency color Doppler ultrasonography for breast and axillary lymph node; in which 77 cases were confirmed by postoperative pathological examination as with axillary lymph node metastasis（axillary lymph node metastasis group）, while another 63 cases were not（no axillary lymph node metastasis group）; with postoperative pathological results as the gold standard, the diagnostic value of preoperative high frequency color Doppler ultrasonography in the diagnosis of axillary lymph node metastasis were calculated. Result In patients with lymph node metastasis, the occurrence of cortical hypertrophy, ratio of long to short axis, lymph node calcification, detection rate of unclear margin were significantly higher than those without metastasis, the difference was statistically significant（P〈0.01）; there was also significant difference of blood flow distribution and blood flow signal grade between the two groups（P〈0.01）; in those with axillary lymph node metastasis, the distribution of blood flow was mainly peripheral type（59.74%）, the grade of blood flow signal was primarily grade 3（71.43%）; in those with no axillary lymph node metastasis, the distribution of blood flow was mainly gate type（11.11%）, the grade of blood flow signal was primarily grade 2（71.43%）; for high frequency color Doppler ultrasonography in the diagnosis of breast cancer with axillary lymph node metastasis, the sensitivity was 89.61%, specificity was 82.54%, the rate of missed diagnosis was 10.39%, and the misdiagnosis rate was 17.46%. Conclusion High frequency color Doppler ultrasonography is clinically applicable in the early diagnosis of axillary lymph node metastasis of breast cancer.