摘要
目的探讨超声在诊断乳腺导管原位癌伴微浸润(breast ductal carcinoma in situ with micro-invasion,DCISM)患者腋窝淋巴结(axillary lymph node,ALN)状态中的临床应用价值。方法回顾性分析山西省肿瘤医院2015年1月~2020年12月经手术病理证实的DCISM患者93例,术前均常规行乳腺及同侧腋窝淋巴结超声检查,术后腋窝淋巴结送病检,以术后病理结果为金标准,将ALN分为转移组和未转移组,对超声所显示的两组淋巴结声像图特征等行对比分析,并使用受试者工作特性(ROC)曲线进行分析和评价。结果本组93例DCISM患者,共有9例发生腋窝淋巴结转移(axillary lymph node metastasis,ALNM),淋巴结转移率为9.68%;术前超声共检出53例淋巴结肿大,ALN的超声检出率为57.0%。超声诊断DCISM患者ALNM的敏感度、特异性、准确度、误诊率及漏诊率分别为66.7%、90.9%、86.8%、9.1%和33.3%。本研究中淋巴结转移组的淋巴结横径及纵横比的均值分别为1.08(0.53~2.15)与1.53(1.29~1.64),与淋巴结未转移组的0.59(0.38~0.88)与2.01(1.17~3.47)比较,差异有统计学意义(P<0.05)。腋窝淋巴结转移组与未转移组在皮质是否增厚、淋巴门是否消失及血流信号丰富程度方面比较,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,超声取淋巴结横径≥0.76cm诊断ALNM的敏感度为88.9%,特异性为95.5%;取淋巴结纵横比≤1.65诊断ALNM的敏感度达100%,特异性为61.5%。结论DCISM患者腋窝淋巴结转移率低,术前超声诊断DCISM患者ALNM的准确度较高,可以为临床手术方案的制定提供有价值的信息。
Objective To explore the diagnostic value of ultrasound in the diagnosis of axillary lymph node(ALN)status in patients with ductal carcinoma in situ micro-invasion(DCISM).Methods A retrospective analysis of 93 patients with DCISM confirmed by pathology and pathology in Shanxi Cancer Hospital from January 2015 to December 2020 was performed.Routine ultrasound examinations of breast and ipsilateral axillary lymph nodes were performed before surgery.The postoperative axillary lymph nodes were sent for medical examination.The postoperative pathological results were the gold standard.ALN was divided into metastatic group and non-metastatic group.The sonographic features of the displaced lymph nodes displayed by ultrasound were compared and analyzed,and the alternating operating characteristic(ROC)curve was used for analysis and evaluation.Results(1)Of the 93 DCISM patients in this group,9 of them developed ALNM,with a lymph node metastasis rate of 9.68%.Preoperative ultrasound detected 53 cases of lymph node enlargement,and the ultrasound detection rate of ALN was 57.0%.The sensitivity,specificity,accuracy,misdiagnosis rate and missed diagnosis rate of ALNM in the diagnosis of DCISM by ultrasound were 66.7%,90.9%,86.8%,9.1%,and 33.3%,respectively.(2)In this study,the mean values of the transverse diameter and aspect ratio of the lymph node in the lymph node metastasis group were 1.08(0.53-2.15)and 1.53(1.29-1.64),respectively,compared with 0.59(0.38-0.88)and 2.01(1.17-3.47)in the non-metastasis group.The difference was statistically significant(all P<0.05).There were also statistically significant differences between the axillary lymph node metastasis group and the non-metastatic group in terms of whether the cortex was thickened,whether the lymphatic hilum disappeared,and the abundance of blood flow signals(P<0.05).(3)ROC curve analysis results showed that the sensitivity of ultrasound to take lymph node transverse diameter≥0.76 cm to diagnose ALNM is was 88.9%,and the specificity is was 95.5%.The sensitivity of ly
作者
史瑶
原韶玲
武壮壮
史泽洪
Shi Yao;Yuan Shaoling;Wu Zhuangzhuang(Department of Medical Imaging,Shanxi Medical University,Shanxi 030001,China)
出处
《医学研究杂志》
2021年第10期142-146,共5页
Journal of Medical Research
