光散射成像预测乳腺浸润性癌腋窝淋巴结转移的作用

Assessing prediction of axillary lymph node status in invasive breast carcinoma by using diffuse optical tomography

目的探讨光散射成像系统在预测浸润性乳腺癌腋窝淋巴结转移中的作用。方法病理确诊为浸润性乳腺癌的141例分为腋窝淋巴结转移组和腋窝淋巴结未转移组,评价术前超声光散射检查肿瘤的各参数(SDI,HBT,SO2)值的差异,通过ROC曲线获得预测腋窝淋巴结转移的阈值,分析超声结合DOT系统对提高腋窝淋巴结转移诊断准确性的意义。结果 141例浸润性乳腺癌患者腋窝淋巴结转移82例,未转移59例,组间SDI、HBT值比较的差异有统计学意义(P=0.007,P=0.002,P<0.01),而患者年龄与SO2值组间比较差异无统计学意义(P=0.83,P=0.712)。ROC曲线得出SDI、HBT诊断阈值为211.00,212.50。超声联合SDI和超声联合HBT诊断腋窝淋巴结转移的敏感性、特异性、准确性、阳性预测值、阴性预测值、AUC分别为:92.68%、94.92%、93.61%、96.20%、90.32%、0.933和91.46%、94.91%、92.91%、96.15%、88.89%、0.925,优于单独使用超声诊断的74.12%、89.83%、82.27%、91.30%、76.61%、0.825。结论结合SDI和HBT值可帮助提高超声诊断腋窝淋巴结转移的准确性。

Objective To investigate the value of diffused optical tomography(DOT) in predicting metastasis of axillary lymph of invasive breast cancer.Methods In total, 141 patients of invasive breast carcinoma were divided into two groups: lymph node-positive and lymph node-negative According to histology.The differences of DOT finding of SDI,HBT,and SO2 was compared between the two groups.Obtain cutoff count of diagnosing axillary metastasis through ROC analysis.Study the value ofultrasound combine with DOT in improving the diagnostic accuracy of axillary lymph node metastasis was analyzed.Results The patients of invasive breast cancer were divided into two groups:metastasis in 82 patients and none metastasis in 59 patients.There were significant differences in SDI,HBT and size between the two groups(P=0.007,P=0.002,P<0.01),and no significant differences in age and SO2(P=0.83,P=0.712).The ROC curve showed that diagnostic threshdds of SDI and HBT were 211.00 and 212.50 in diagnosing of axillary metastasis.The sensitivity,specificity, accuracy, positive predictive value, negative predictive value,AUC of ultrasound with SDI and ultrasound with HBT were 92.68%,94.92%,93.61%,96.20%,90.32%,0.933 and 91.46%,94.91%,92.91%,96.15%,88.89%,0.925,and significantly greater than those of ultrasound alone(74.12%,89.83%,82.27%,91.30%,76.61%,0.825).Conclusion Combining SDI and HBT values can improve the accuracy of ultrasound diagnosis of axillary lymph node metastasis.