CAJ | 학술논문

目的：探讨B超判断乳腺癌腋窝淋巴结转移状态的临床应用价值。方法纳入2014年2～12月军事医学科学院附属医院乳腺外科200例女性初治乳腺疾病患者，中位年龄50岁。其中乳腺癌患者153例，乳腺炎患者2例，巨大纤维瘤1例，纤维腺瘤44例。良性乳腺疾患腋窝淋巴结不作处理；乳腺癌患者腋窝淋巴结行前哨淋巴结活检，转移阳性或临床可疑时行腋窝淋巴结清扫。所有淋巴结均行石蜡病理检查。由具有20年以上B超检查经验的医师在不明原发病诊断情况下评估腋窝淋巴结转移状态。根据淋巴结B超影像学特征结合B超医师经验，将患者分为腋窝淋巴结转移组、可疑组和未转移组。对照术后病理诊断结果，分析B超判断腋窝淋巴结转移的灵敏度、特异度、阳性及阴性预测值、假阴性率及假阴性患者腋窝淋巴结肿瘤转移负荷，并对B超各参数在判断腋窝淋巴结转移的作用进行单因素分析。结果 B超判断上述3组的转移率分别为84．51％、45．16％和7．14％；转移组＋未转移组B超判断腋窝淋巴结的转移的灵敏度、特异度、阳性及阴性预测值分别为89．6％、89．1％、84．5％和92．7％；转移组＋未转移组B超判断腋窝淋巴结转移与病理诊断结果的一致性分析显示，Kappa值为0．779；7例B超判断假阴性患者，腋窝淋巴结转移负荷均只有1枚。单因素分析提示，淋巴结纵径≥1 cm，其转移率明显高于纵径＜1 cm，分别为44．2％／14．3％（P＜0．001）；淋巴结纵横比≤1．5的淋巴结转移率显著高于纵横比＞1．5，为65．6％／35．1％（P＜0．001）；淋巴结皮质厚度≥3 mm的转移率达67．5％，＜3 mm的淋巴结转移率仅为1．2％（P＜0．001）；淋巴结出现中央型或混合型血流信号，淋巴结转移率分别达75％及79％（P＜0．001）。结论 B超可准确判断部分患者腋窝淋巴结转移状态；假阴性患者腋窝淋巴结转移负荷较低；纵径≥1 cm、纵横比≤1．5、皮质厚度≥3 mm及出现中央型或混合型血流信号与淋巴结转移相关。对于早期乳腺癌，B超可能是潜在的替代前哨腋窝淋巴结活检进行腋窝淋巴结分期的手段。目的：探討B超判斷乳腺癌腋窩淋巴結轉移狀態的臨床應用價值。方法納入2014年2～12月軍事醫學科學院附屬醫院乳腺外科200例女性初治乳腺疾病患者，中位年齡50歲。其中乳腺癌患者153例，乳腺炎患者2例，巨大纖維瘤1例，纖維腺瘤44例。良性乳腺疾患腋窩淋巴結不作處理；乳腺癌患者腋窩淋巴結行前哨淋巴結活檢，轉移暘性或臨床可疑時行腋窩淋巴結清掃。所有淋巴結均行石蠟病理檢查。由具有20年以上B超檢查經驗的醫師在不明原髮病診斷情況下評估腋窩淋巴結轉移狀態。根據淋巴結B超影像學特徵結閤B超醫師經驗，將患者分為腋窩淋巴結轉移組、可疑組和未轉移組。對照術後病理診斷結果，分析B超判斷腋窩淋巴結轉移的靈敏度、特異度、暘性及陰性預測值、假陰性率及假陰性患者腋窩淋巴結腫瘤轉移負荷，併對B超各參數在判斷腋窩淋巴結轉移的作用進行單因素分析。結果 B超判斷上述3組的轉移率分彆為84．51％、45．16％和7．14％；轉移組＋未轉移組B超判斷腋窩淋巴結的轉移的靈敏度、特異度、暘性及陰性預測值分彆為89．6％、89．1％、84．5％和92．7％；轉移組＋未轉移組B超判斷腋窩淋巴結轉移與病理診斷結果的一緻性分析顯示，Kappa值為0．779；7例B超判斷假陰性患者，腋窩淋巴結轉移負荷均隻有1枚。單因素分析提示，淋巴結縱徑≥1 cm，其轉移率明顯高于縱徑＜1 cm，分彆為44．2％／14．3％（P＜0．001）；淋巴結縱橫比≤1．5的淋巴結轉移率顯著高于縱橫比＞1．5，為65．6％／35．1％（P＜0．001）；淋巴結皮質厚度≥3 mm的轉移率達67．5％，＜3 mm的淋巴結轉移率僅為1．2％（P＜0．001）；淋巴結齣現中央型或混閤型血流信號，淋巴結轉移率分彆達75％及79％（P＜0．001）。結論 B超可準確判斷部分患者腋窩淋巴結轉移狀態；假陰性患者腋窩淋巴結轉移負荷較低；縱徑≥1 cm、縱橫比≤1．5、皮質厚度≥3 mm及齣現中央型或混閤型血流信號與淋巴結轉移相關。對于早期乳腺癌，B超可能是潛在的替代前哨腋窩淋巴結活檢進行腋窩淋巴結分期的手段。
목적：탐토B초판단유선암액와림파결전이상태적림상응용개치。방법납입2014년2～12월군사의학과학원부속의원유선외과200례녀성초치유선질병환자，중위년령50세。기중유선암환자153례，유선염환자2례，거대섬유류1례，섬유선류44례。량성유선질환액와림파결불작처리；유선암환자액와림파결행전초림파결활검，전이양성혹림상가의시행액와림파결청소。소유림파결균행석사병리검사。유구유20년이상B초검사경험적의사재불명원발병진단정황하평고액와림파결전이상태。근거림파결B초영상학특정결합B초의사경험，장환자분위액와림파결전이조、가의조화미전이조。대조술후병리진단결과，분석B초판단액와림파결전이적령민도、특이도、양성급음성예측치、가음성솔급가음성환자액와림파결종류전이부하，병대B초각삼수재판단액와림파결전이적작용진행단인소분석。결과 B초판단상술3조적전이솔분별위84．51％、45．16％화7．14％；전이조＋미전이조B초판단액와림파결적전이적령민도、특이도、양성급음성예측치분별위89．6％、89．1％、84．5％화92．7％；전이조＋미전이조B초판단액와림파결전이여병리진단결과적일치성분석현시，Kappa치위0．779；7례B초판단가음성환자，액와림파결전이부하균지유1매。단인소분석제시，림파결종경≥1 cm，기전이솔명현고우종경＜1 cm，분별위44．2％／14．3％（P＜0．001）；림파결종횡비≤1．5적림파결전이솔현저고우종횡비＞1．5，위65．6％／35．1％（P＜0．001）；림파결피질후도≥3 mm적전이솔체67．5％，＜3 mm적림파결전이솔부위1．2％（P＜0．001）；림파결출현중앙형혹혼합형혈류신호，림파결전이솔분별체75％급79％（P＜0．001）。결론 B초가준학판단부분환자액와림파결전이상태；가음성환자액와림파결전이부하교저；종경≥1 cm、종횡비≤1．5、피질후도≥3 mm급출현중앙형혹혼합형혈류신호여림파결전이상관。대우조기유선암，B초가능시잠재적체대전초액와림파결활검진행액와림파결분기적수단。
Objective To assess the clinical application value of axillary lymph node staging of breast cancer by B ultrasound.Methods From February to December 2014, 200 female breast disease patients in Department of Breast Surgery Affiliated Hospital of Academy of Military Medical Sciences, were enrolled, with median age 50 years old, including 153 cases of breast cancer, 44 cases of fibroadenoma, 2 cases of mastitis and a case of huge fibroma.The state of axillary lymph node was assessed by doctor with more than twenty years experience in B ultrasound diagnosis.According to the characteristics of the ultrasound image of lymph node and experience of the B ultrasound doctor, the patients were divided into axillary lymph node metastasis group, suspicious group and no metastasis group.The axillary lymph nodes were staged by sentinel lymph node biopsy or axillary lymph node dissection.Based on pathological diagnosis and results of the ultrasound, the sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, and metastasis burden of axillary lymph nodes in false negative patients were analyzed.The relationship between the B ultrasound characteristics and axillary lymph node metastasis was also studied by univariate analysis.Results The metastasis rate of above-mentioned 3 groups by B ultrasound was 84.51%, 45.16% and 7.14%, respectively.The sensitivity, specificity, positive predictive value and negative predictive value of screening for axillary lymph node metastasis by B ultrasound were 89.6%, 89.1%, 84.5% and 92.7%, respectively in metastasis group and no metastasis group. According to consistency analysis between pathological diagnosis and B ultrasound, the Kappa value was 0.779.The false negative rate was only 7.1%(7/98 cases) in no metastasis group judged by B ultrasound, and the patients′axillary lymph node metastasis burden was very low, with only one lymph node positive.The univariate analysis showed that patients with longitudinal diameter of lymph nodes≥1 cm had a higher risk for metastasis than <1 cm (44.2%/14.3%,P<0.001);lymph node aspect ratio≤1.5, the lymph node metastasis rate was significant higher than>1.5(P<0.001); cortical thickness≥3 mm and lymph node appearing blood flow signal of the central or mixed type were also high metastasis risk factor, the lymph node metastasis rate was 67.5%, 75%and 79%, respectively, P<0.001).Conclusion B Ultrasound is a valuable method for detecting axillary lymph node metastasis in breast cancer.It has lower false negative rate, and the false negative patients just have smaller axillary lymph node metastasis burden.The longitudinal diameter of lymph nodes more than 1 cm, lymph node aspect ratio≤1.5, lymph node of cortical thickness≥3 mm, and blood flow signal of the central or mixed type have higher relationship with axillary lymph node metastasis.B Ultrasound may be a potential alterative method for sentinel axillary lymph node biopsy for axillary lymph node staging in early breast cancer.