超声引导下针吸活检在乳腺癌内乳淋巴结诊断中的应用

Application of ultrasound-guided needle aspiration in diagnosis of internal mammary lymph nodes in breast cancer

目的探讨超声引导下针吸活检(FNA)在乳腺癌内乳淋巴结(IMN)诊断中的应用价值。方法选取疑似IMN的乳腺癌患者160例为研究对象,均在超声引导下行IMN穿刺活检,88例采用空芯针活检(CNB,CNB组),72例采用FNA(FNA组)。对照病理诊断结果,分析比较FNA与CNB对IMN的诊断效能。结果FNA组的IMN最大直径、IMN最大厚径均小于CNB组,差异有统计学意义(P<0.05);2组穿刺诊断的IMN分型比较,差异无统计学意义(P>0.05)。2组穿刺标本不满意率、IMN阳性率比较,差异均无统计学意义(P>0.05)。一致性检验结果显示,CNB组和FNA组与病理诊断的一致性良好(Kappa>0.70);与CNB组比较,FNA组一致性更高(Kappa=0.890)。CNB组与FNA组诊断IMN的敏感度、特异度、阳性预测值比较,差异均无统计学意义(P>0.05);CNB组阴性预测值低于FNA组,假阴性率高于FNA组,差异均有统计学意义(P<0.05)。CNB组8例(9.09%)发生穿刺并发症,包括轻症或无症状气胸6例、穿刺肌间出血2例,症状均较轻微,FNA组未发生穿刺并发症。结论超声引导下FNA对乳腺癌IMN的定性诊断的效能较高,且FNA的穿刺风险小,并发症少,更适合解剖位置特殊的IMN穿刺活检。

Objective To investigate the application value of ultrasound-guided fine needle aspiration(FNA)in the diagnosis of internal mammary nodes(IMN)in breast cancer.Methods A total of 160 breast cancer patients with suspected IMN were selected as the study subjects.All patients underwent IMN puncture biopsy under ultrasound guidance,with 88 cases in core needle biopsy(CNB)group and 72 cases in FNA group.The diagnostic efficacy of FNA and CNB for IMN was analyzed and compared according to pathological diagnosis results.Results The maximum diameter and maximum thickness of IMN in the FNA group were smaller than those in the CNB group(P<0.05).There was no statistically significant difference in the classification of IMN diagnosed by puncture between the two groups(P>0.05).There were also no statistically significant differences in the unsatisfactory rate of puncture specimens and the positive rate of IMN between the two groups(P>0.05).The consistency test results showed good consistency of the CNB and FNA groups compared with pathological diagnosis(Kappa>0.70);compared with the CNB group,the consistency of the FNA group was higher(Kappa=0.890).There were no statistically significant differences in the sensitivity,specificity,and positive predictive value of IMN diagnosis between the CNB and FNA groups(P>0.05);the negative predictive value of the CNB group was lower than that of the FNA group,and the false-negative rate was higher(P<0.05).Eight cases(9.09%)in the CNB group developed puncture complications,including 6 cases of mild or asymptomatic pneumothorax and 2 cases of intermuscular hemorrhage,with relatively mild symptoms.No puncture complications occurred in the FNA group.Conclusion Ultrasound-guided FNA has a high efficacy in the qualitative diagnosis of IMN in breast cancer,with low puncture risk and fewer complications,making it more suitable for IMN puncture biopsy in special anatomical locations.