超声造影结合细针穿刺活检对乳腺癌前哨淋巴结的诊断效率

Diagnostic value of ultrasonography guided with fine needle aspiration biopsy of sentinel lymph nodes of breast cancer

目的探讨超声造影结合细针穿刺对乳腺癌前哨淋巴结(SLN)的诊断价值。方法回顾性分析2015年12月至2019年12月行手术切除术80例单发乳腺癌患者资料,对所有患者术前进行超声造影和细针穿刺活检,以术后病理诊断结果为金标准,采用SPSS 20.0对数据进行分析,灵敏度、特异度、准确度等计数资料采用配对χ^(2)检验。绘制二者联合检测对SLN诊断的ROC曲线,并计算其曲线下面积(AUC)。以P<0.05为差异有统计学意义。结果经病理诊断,腋窝淋巴结阳性率为91.3%(73/80)。超声造影检查腋窝淋巴结转移67例,阴性13例。诊断准确度为87.5%(70/80),灵敏度为89.0%(65/73),特异度为71.4%(5/7)。细针穿刺活淋巴引流区常规操作手术域检结果显示,有63例患者诊断为阳性,阴性17例。诊断准确度为82.5%(66/80),灵敏度为83.6%(61/73),特异度为71.4%(5/7)。二者联合检淋巴引流区常规操作手术域测结果显示,有71例患者诊断淋巴引流区常规操作手术域为阳性,阴性9例。诊断准确度为92.5%(74/80),灵敏度为94.5%(69/73),特异度为71.4%(5/7)。二者联合检测的其AUC(0.891)明显大于单独超声造影的AUC(0.835)与单独细针穿刺活检的AUC(0.758)(P<0.05)。结论超声造影结合细针穿刺活检能够提高对乳腺癌SLN诊断的准确度和灵敏度,具有较高的诊断价值,值得在临床上推广应用。

Objective To explore the diagnostic value of ultrasonography guided with fine needle aspiration biopsy of sentinel lymph nodes(SLN)of breast cancer.Methods The clinical data of 80 patients with single breast cancer underwent the surgical resection from December 2015 to December 2019 were analyzed retrospectively.All of 80 patients received preoperative contrast-enhanced ultrasound test as well as fine needle aspiration biopsy.The postoperative pathological diagnosis was considered as the gold standard.Statistical analysis were performed by using SPSS20.0 software.The degree of sensitivity,specific,and accuracy data were analyzed by usingχ^(2) test.The ROC curve of ultrasonography guided with fine needle aspiration biopsy of SLN was plotted,and the area under the curve(AUC)was calculated.A P value of<0.05 was considered as statistically significant difference.Results The positive rate of pathological diagnosis of axillary lymph node was 91.3%(73/80).67 patients had axillary lymph node metastasis under contrast-enhanced ultrasound.The diagnostic accuracy was 87.5%(70/80),sensitivity was 89.0%(65/73),and the specificity was 71.4%(5/7).Fine needle aspiration biopsy results showed that 63 cases of positive,while 17 cases of negative.The diagnostic accuracy was 82.5%(66/80),sensitivity was 83.6%(61/73),and the specificity was 71.4%(5/7).The guided test results of the two methods showed that 71 patients were diagnosed as positive and 9 patients were diagnosed as negative.The diagnostic accuracy was 92.5%(74/80),sensitivity was 94.5%(69/73),and the specificity was 71.4%(5/7).The ROC curve was drawn for the diagnosis of SLN in patients with breast cancer.The results showed that the AUC(0.891)of the guided detection was significantly greater than that of ultrasound contrast AUC(0.835)and fine needle aspiration biopsy(0.758)(P<0.05).Conclusion Ultrasonography guided fine-needle aspiration biopsy could improve the accuracy and sensitivity of the sentinel lymph node diagnosis of patients with breast cancer.It has high diagnostic value and is worthy of clinical application.