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目的探讨超声检查评估乳腺癌腋窝淋巴结转移状态的临床应用价值。方法入组军事医学科学院附属医院2013年12月至2015年9月期间连续收治的282例新发Tis-T2期乳腺癌患者,指定2名高年资超声医师行腋窝超声检查,根据淋巴结声像学参数,将患者分为转移组、未转移组或可疑组。腋窝淋巴结分期以病理学结果作为金标准,分析超声检查评估乳腺癌腋窝淋巴结转移的准确性,比较各组腋窝淋巴结转移负荷;单因素及多因素Logistic回归分析各个声像学参数对判断腋窝淋巴结转移状态的预测价值。结果超声判断腋窝淋巴结转移组+未转移组的灵敏度、特异度、阳性及阴性预测值、准确度分别为85.6%、87.1%、86.4%、86.3%和86.3%,Kappa值为0.727(P<0.001)。在病理证实腋窝淋巴结转移患者中,超声判断未转移组的平均淋巴结转移负荷明显低于超声转移组(1.2/6.9枚,P<0.001),超声判断为未转移而病理结果证实为转移的患者共16例,其中14例患者腋窝淋巴结转移负荷仅为1枚,其余2例患者分别为2枚和3枚。单因素Logistic回归分析显示,最大皮质厚度预测腋窝淋巴结转移诊断效能最佳(ROC曲线下面积为0.872);多因素Logistic回归分析显示,最大皮质厚度、髓质与皮质厚度比值与腋窝淋巴结转移相关(P<0.05)。多因素Logistic回归模型ROC曲线下面积为0.879,灵敏度及特异度分别为77.0%和85.1%。结论超声检查评估腋窝淋巴结转移具有较高的准确性;超声判断假阴性的患者腋窝淋巴结转移负荷较低。最大皮质厚度是判断腋窝淋巴结转移最主要的声像学参数。在早期乳腺癌患者中,超声检查无创评估可能是潜在的替代前哨淋巴结活检行腋窝淋巴结分期的手段。
Objective To investigate the clinical value of ultrasonography in assessing axillary lymph node metastasis in breast cancer. Methods Two hundred and eighty-two patients with newly diagnosed Tis-T2 breast cancer admitted to Affiliated Hospital of Academy of Military Medical Sciences from December 2013 to September 2015 were enrolled in this study. Two high-powered sonographers were selected for axillary ultrasonography. According to lymph node imaging Learning parameters, the patients were divided into metastasis group, non-metastasis group or suspicious group. Axillary lymph node staging with pathological results as the gold standard, analysis of ultrasound examination to assess the accuracy of axillary lymph node metastasis of breast cancer, axillary lymph node metastasis load comparison; univariate and multivariate Logistic regression analysis of various imaging parameters to determine axillary lymph node metastasis The predictive value of the state. Results The sensitivity, specificity, positive and negative predictive values were 85.6%, 87.1%, 86.4%, 86.3% and 86.3%, respectively, Kappa value was 0.727 (P <0.001) in axillary lymph node metastasis group and non-metastasis group ). In patients with axillary lymph node metastasis confirmed by pathology, the mean lymph node metastasis burden in the untransferred group was significantly lower than that in the ultrasound group (1.2 / 6.9, P <0.001). The total number of patients with metastasis 16 cases, of which 14 cases of axillary lymph node metastasis load was only 1, the remaining 2 patients were 2 and 3. Univariate Logistic regression analysis showed that the maximal cortical thickness predicted the best diagnosis of axillary lymph node metastasis (ROC area under the curve of 0.872); multivariate Logistic regression analysis showed that the ratio of maximal cortical thickness to medulla and cortical thickness was correlated with axillary lymph node metastasis P <0.05). The area under the ROC curve of the multivariate logistic regression model was 0.879, the sensitivity and specificity were 77.0% and 85.1% respectively. Conclusion Ultrasonography has a high accuracy in assessing the axillary lymph node metastasis. The patients with false negative ultrasound are less likely to have axillary lymph node metastases. The maximum cortical thickness is the most important sonographic parameters for judging the axillary lymph node metastasis. In early breast cancer patients, noninvasive assessment of ultrasound may be a potential alternative to sentinel lymph node biopsy axillary lymph node staging.