CAJ | 학술논문

目的：初步探讨超声、钼靶及核磁在早期乳腺癌及腋窝淋巴结状态评价方面的意义。方法回顾性分析281例行前哨淋巴结活检术女性乳腺癌患者的相关临床病理及影像学检查资料。结果秩和检验显示乳腺超声、钼靶及核磁三种方式在客观反映肿瘤实际病理大小方面无统计学差异，但超声检查结果最接近实际病理大小。仅超声提示结果的P值小于0.05，对腋窝淋巴结状态的预测效果的单因素分析显示超声提示结果的P值为0.006，具有统计学意义。而核磁提示结果的P值为0.055，趋于有统计学意义；其余变量的P值均大于0.05，无统计学意义。预测腋窝淋巴结状态的真实性评价中，血流信号、超声提示结果及核磁提示结果的约登指数均大于0，提示对腋窝淋巴结是否转移有一定的预测价值。但有无淋巴门结构、有无血流信号、超声淋巴结长短径、超声提示有无转移及核磁提示有无转移的诊断ROC曲线下面积均小于0.6，即单一参数诊断效果不是十分理想。结论临床常规乳腺检测手段均能够准确反映肿瘤实际大小，以超声最佳，能够客观评价腋窝淋巴结状态并为临床治疗决策提供指导意义。
목적：초보탐토초성、목파급핵자재조기유선암급액와림파결상태평개방면적의의。방법회고성분석281례행전초림파결활검술녀성유선암환자적상관림상병리급영상학검사자료。결과질화검험현시유선초성、목파급핵자삼충방식재객관반영종류실제병리대소방면무통계학차이，단초성검사결과최접근실제병리대소。부초성제시결과적P치소우0.05，대액와림파결상태적예측효과적단인소분석현시초성제시결과적P치위0.006，구유통계학의의。이핵자제시결과적P치위0.055，추우유통계학의의；기여변량적P치균대우0.05，무통계학의의。예측액와림파결상태적진실성평개중，혈류신호、초성제시결과급핵자제시결과적약등지수균대우0，제시대액와림파결시부전이유일정적예측개치。단유무림파문결구、유무혈류신호、초성림파결장단경、초성제시유무전이급핵자제시유무전이적진단ROC곡선하면적균소우0.6，즉단일삼수진단효과불시십분이상。결론림상상규유선검측수단균능구준학반영종류실제대소，이초성최가，능구객관평개액와림파결상태병위림상치료결책제공지도의의。
Objective To explore the evaluation of ultrasound, mammography and MRI in the early breast can-cer and diagnosis of lymph node metastasis. Method The clinical data of 281 female breast cancer patients under-went completion axillary lymph node dissection( CALND), when the sentinel lymph node is positive, at Cancer Insti-tute and Hospital affiliated to Chinese Academy of Medical Sciences from July 2010 to August 2011 was collected and analyzed retrospectively. Result In nonparametric tests, all ultrasound, mammography and MRI can reflect the exact size of the tumors with a non-statistically significant P value, while the ultrasound predictedthe best. In Chi square test, only lymph node status diagnosed by ultrasound has a P value less than 0.05. And lymph node status di-agnosed by MRI tended to be significantly different (P=0.055), while the P value of all the other parameters have no significance. Color doppler flow imaging and lymph node status diagnosed by ultrasound and MRI can predict the metastasis of axillary lymph node in one way with a Youden index more than 0. However, the ROCs of lymph node status diagnosed by MRI or ultrasound, hilum of lymph node, the ratio of long to short diameter and blood stream are all <0.6, it indicates single diameter cannot predict the metastasis of axillary lymph node well. Conclusion Im-aging methods can evaluate the size of malignant tumors exactly and especially the ultrasound. Lymph node status diagnosed by ultrasonography can predict the true axillary lymph node status and help the surgeon to make decisions.