超声造影诊断浸润性乳腺癌腋窝淋巴结转移价值及其影响因素分析

Value of contrast-enhanced ultrasonography in diagnosing axillary lymph node metastasis of invasive breast cancer and the analysis of influencing factors of that

目的:研究超声造影在浸润性乳腺癌腋窝淋巴结转移诊断中的价值,探究超声造影参数与浸润性乳腺癌腋窝淋巴结转移的相关性。方法:选取医院收治的69例确诊乳腺癌且存在肿大腋窝淋巴结(89枚)患者,根据病理结果的良恶性,将其分为良性组(33枚)和转移组(56枚)。所有患者均行腋窝淋巴结常规超声、超声造影及联合检查,观察两组淋巴结的大小、形态、长径/短径(L/S)比值、内部回声及彩色多普勒血流显像(CDFI),记录造影的模式及时间。采用受试者工作特征(ROC)曲线分析3种检查方法在浸润性乳腺癌腋窝淋巴结转移诊断中的价值。采用单因素、多因素Cox回归分析超声造影诊断淋巴结转移的影响因素。结果:常规超声检查结果中,转移组患者淋巴结L/T比值(1.13±0.12)明显低于良性组(2.15±0.26),差异有统计学意义(t=2.99,P<0.05);良性组CDFI血流分型多为淋巴门型,转移组多为周围或混合型,两组差异有统计学意义(χ^(2)=24.27,P<0.05)。超声造影中,良性组强化模式以中央均匀强化为主,而转移组以周围型或混合型强化为主,两组间不同的强化模式血流分型差异有统计学意义(χ^(2)=45.40,P<0.05)。良性组造影强化时间(188.56±48.52)ms,明显短于转移组的(372.50±63.50)ms,差异有统计学意义(t=2.64,P<0.01)。常规超声、超声造影和联合诊断淋巴结转移的ROC曲线下面积(AUC)分别为0.636、0.798和0.869,灵敏度分别为57.14%、66.07%和82.14%,特异度分别为75.75%、84.85%和90.91%。淋巴结周围存在声晕、血流分级Ⅱ~Ⅲ级、增强不均匀及淋巴结径线等均是超声造影诊断淋巴结转移的影响因素。结论:常规超声及超声造影为诊断浸润性乳腺癌腋窝淋巴结转移的有效方法,两者联合诊断浸润性乳腺癌腋窝淋巴结转移较单独诊断具有较高的灵敏度、特异度及准确率。

Objective:To analyze the value of contrast-enhanced ultrasonography in the diagnosis of axillary lymph node metastasis of invasive breast cancer,and explore the correlation between the parameters of contrast-enhanced ultrasonography and invasive breast cancer.Methods:69 patients with breast cancer and swollen axillary lymph nodes(89 nodes)were selected.89 swollen lymph nodes were divided into benign group(33 nodes)and metastatic group(56 nodes)according to the benign or malignant results of pathological examination of lymph nodes.All patients underwent conventional ultrasound,contrast-enhanced ultrasonography and combined examination on their axillary lymph nodes.The size,shape and the ratio of length and short diameter of lymph nodes,internal echo and color Doppler flow imaging(CDFI)of two groups were observed,and the mode and time of contrast-enhanced ultrasonography were recorded.The receiver operating characteristics(ROC)curve was adopted to analyze the values of three examination methods in the diagnosis of axillary lymph node metastasis of invasive breast cancer.The single factor and multi-factor Cox regression analysis were adopted to analyze the influence factors of contrast-enhanced ultrasonography in diagnosing lymph mode metastasis.Results:The results of conventional ultrasound showed that the L/S ratio(1.13±0.12)of lymph nodes of metastasis group was significantly lower than that(2.15±0.26)of benign group,and the difference was statistically significant(t=2.99,P<0.05).The typing of CDFI blood flow of benign group was mainly lymph Hilar type,and that of metastasis group was mainly peripheral or mixed type,and the difference was statistically significant(χ^(2)=24.27,P<0.05).The results of contrast-enhanced ultrasonography showed that the enhancement pattern of benign group was mainly central homogeneous enhancement,while that of metastasis group was mainly peripheral or mixed enhancement,and the difference of the typing of the blood flow of different enhancement mode between the two groups was statistically significant(χ^(2)=45.40,P<0.05).The enhancement time(188.56±48.52)ms of benign group was significantly shorter than that(372.50±63.50)ms of metastasis group,and the difference was statistically significant(t=2.64,P<0.01).The areas under curve(AUC)of ROC of conventional ultrasound,contrast-enhanced ultrasonography and combined diagnosis of lymph node metastasis were respectively 0.636,0.798 and 0.869,and the sensitivities of them respectively were 57.14%,66.07%and 82.14%,and the specificities of them respectively were 75.75%,84.85%and 90.91%.The presence of acoustic halo around lymph nodes,grade II-III of blood flow grading,uneven of enhancement and the equality of diameter line of lymph node were the influencing factors in the diagnosis of lymph node metastasis by contrast-enhanced ultrasonography.Conclusion:Conventional ultrasound and contrast-enhanced ultrasonography are effective methods for the diagnosis of axillary lymph node metastasis of invasive breast cancer.Compared with the diagnosis of single method,the combination of the two methods has higher sensitivity,specificity and accuracy.