术前超声造影对乳腺癌前哨淋巴结转移的预测价值

Predictive value of preoperative contrast-enhanced ultrasound in sentinel lymph node metastasis of breast cancer

目的:分析术前超声造影对乳腺癌前哨淋巴结转移的预测价值。方法:选择乳腺癌病人276例,术前均行超声造影检查寻找前哨淋巴结,将病理学检查结果和超声造影结果进行对比,计算超声造影敏感性、特异性、阳性预测值、阴性预测值及准确率。结果:276例病人中,124例肿瘤位于左乳,152例位于右乳;100例肿瘤部位在外上象限,47例在外下象限,60例在内上象限,69例在内下象限;所有病人均经病理证实为原发性乳腺癌,其中183例为浸润性导管癌,65例为导管内原位癌,16例为黏液癌,12例为其他;原发肿瘤直径0.6~4.9 cm,前哨淋巴结直径0.3~3.2 cm。术前超声造影共检出497枚前哨淋巴结,手术共切除518枚前哨淋巴结,术前超声造影对前哨淋巴结的检出率为95.95%(497/518);病理学检查确认存在120枚转移前哨淋巴结。术前超声造影预测前哨淋巴结阳性病人73例,阴性病人203例,其对有无前哨淋巴结的预测灵敏性76.12%,特异性89.47%,阳性预测值69.86%,阴性预测值92.12%,准确率86.23%。结论:术前超声造影还需联合其他示踪方式对乳腺癌前哨淋巴结转移情况进行预测,才能获得最佳效果。

Objective:To analyze the predictive value of preoperative contrast-enhanced ultrasound in sentinel lymph node metastasis of breast cancer.Methods:The contrast-enhanced ultrasound in 276 patients with breast cancer were performed to find sentinel lymph nodes.The results between pathological examination and contrast-enhanced ultrasound were compared.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of contrast-enhanced ultrasound in all cases were calculated.Results:Of the 276 patients,124 tumors were located in the left breast and 152 tumors were located in the right breast.There were 100 cases in the outer upper quadrant,47 cases in the outer lower quadrant,60 cases in the inner upper quadrant and 69 cases in the inner lower quadrant.All patients were pathologically confirmed as primary breast cancer,which included 183 cases of invasive ductal carcinoma,65 cases of intraductal carcinoma in situ,16 cases of mucinous carcinoma and 12 cases of other cancers.The diameter of the primary tumor was 0.6-4.9 cm,and the diameter of the sentinel lymph node was 0.3-3.2 cm.A total of 497 sentinel lymph nodes were detected by preoperative contrast-enhanced ultrasound,and a total of 518 sentinel lymph nodes were removed by operation.The detection rate of preoperative contrast-enhanced ultrasound of sentinel lymph nodes was 95.95%(497/518).The results of pathological examination confirmed that 120 nodes were metastatic sentinel nodes.Seventy-three patients with positive and 203 patients with negative sentinel lymph nodes were predicted using the preoperative contrast-enhanced ultrasound.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of predicting sentinel lymph nodes were 76.12%,89.47%,69.86%,92.12%and 86.23%,respectively.Conclusions:In order to get the best predicting results in the sentinel lymph node metastasis of breast cancer,the contrast-enhanced ultrasound should be combined with other tracing methods.