超声和钼靶X线对乳腺癌患者腋窝淋巴结转移的诊断价值

Diagnostic value of ultrasonography and molybdenum target X-ray for axillary lymph node metastasis in patients with breast cancer

目的探讨超声和钼靶X线对乳腺癌患者腋窝淋巴结转移的诊断价值,为临床是否选择前哨淋巴结活检(SLNB)提供指导。方法选择532例行SLNB并经术后病理检查确诊的原发性乳腺癌患者,所有患者术前均接受乳腺超声和乳腺钼靶X线检查,分析乳腺超声、乳腺钼靶X线征象与腋窝淋巴结转移的关系。以病理诊断结果为金标准,分析乳腺超声、乳腺钼靶X线及SLNB对腋窝淋巴结转移的诊断价值。结果532例患者中,腋窝淋巴结转移272例,未转移260例。乳腺超声检查结果显示,腋窝淋巴结转移和未转移乳腺癌患者的肿块直径、边界情况、淋巴结长短径之比、乳腺影像报告及数据系统(BI-RADS)分级比较,差异均有统计学意义(P﹤0.01)。乳腺钼靶X线检查结果显示,腋窝淋巴结转移的乳腺癌患者恶性钙化的发生率明显高于腋窝淋巴结未转移的患者,差异有统计学意义(P﹤0.01)。以病理诊断结果为金标准,SLNB诊断腋窝淋巴结转移的灵敏度和特异度最高,分别为93.01%和97.31%,其次是乳腺超声,其灵敏度和特异度分别为84.93%和92.69%,乳腺钼靶X线诊断腋窝淋巴结转移的灵敏度和特异度最低,分别为49.63%和71.54%。结论腋窝淋巴结转移和未转移乳腺癌患者的乳腺超声和乳腺钼靶X线征象具有一定的差异。乳腺超声和乳腺钼靶X线对腋窝淋巴结转移具有一定的诊断价值,且对是否选择SLNB具有指导意义。

Objective To investigate the diagnostic value of ultrasonography and molybdenum target X-ray in axillary lymph node metastasis of breast cancer patients, and to provide guidance for clinical selection of sentinel lymph node biopsy (SLNB). Method 532 patients with primary breast cancer who underwent SLNB and confirmed by pathology after operation were selected. All patients underwent ultrasonography and molybdenum target X-ray examination before operation. The relationship between ultrasonography, molybdenum target X-ray signs and axillary lymph node metastasis was analyzed. The diagnostic value of ultrasonography, molybdenum target X-ray and SLNB in axillary lymph node metastasis was evaluated, pathological results as the gold standard. Result Among 532 patients, 272 had axillary lymph node metastasis and 260 had no metastasis. The results of breast ultrasonography showed that there were significant differences between axillary lymph node metastasis and non-metastatic breast cancer in the diameter, boundary condition, ratio of lymph node length to short diameter, breast imaging reporting and data system (BI-RADS) classification (P<0.01). The molybdenum target X-ray results showed that the incidence of malignant calcification in breast cancer patients with axillary lymph node metastasis was significantly higher than that in patients without axillary lymph node metastasis (P< 0.01). Pathological results as the gold standard, the sensitivity and specificity of SLNB in the diagnosis of axillary lymph node metastasis were the highest, 93.01% and 97.31% respectively, followed by breast ultrasonography, with sensitivity and specificity of 84.93% and 92.69%, respectively. The sensitivity and specificity of molybdenum target X-ray in the diagnosis of axillary lymph node metastasis were the lowest, 49.63% and 71.54%, respectively. Conclusion Ultrasonography and molybdenum target X-ray findings of axillary lymph node metastasis and non-metastatic breast cancer are different. Ultrasonography and molybdenum target X-ray have certain diagnostic value for axillary lymph node metastasis and can provide guidance for SLNB selection.