多种影像学手段评估乳腺癌患者腋窝淋巴结状态的对比研究
摘要
目的:探讨不同的影像学检查及联合应用在乳腺癌患者腋窝淋巴结状态评估方面的价值。方法:回顾性分析2016年9月—2018年8月间南京医科大学第一附属医院乳腺外科住院的195例乳腺癌患者的超声、钼靶、磁共振(MRI)及CT检查资料和临床病理结果。计算不同影像学方法以及联合应用2种及以上方法评估腋窝淋巴结状态的敏感性,特异性,阳性预测值、阴性预测值、准确度、约登指数以及Kappa值。结果:共有78例(40%)存在腋窝淋巴结转移,乳腺磁共振敏感性,约登指数及Kappa值最高,为82.1%、0.590和0.574。两两联合检查中,MRI+CT联合进行平行诊断试验敏感性最高,为85.7%,超声+CT联合进行系列诊断试验特异性最高,为93.2%,4项联合检查结果一致时准确率最高,为88.9%,差异有统计学意义(P <0.05)。结论:综合分析乳腺癌腋窝淋巴结术前影像学评估手段,MRI诊断效能最高。不同的联合检查具有不同优势,术前常规联合应用多种影像学检查及综合分析可以提高术前评估的准确性。
引文
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[17]Kuijs V J,Moossdorff M,Schipper R J,et al. The role of MRI in axillary lymph node imaging in breast cancer patients:a systematic review[J]. Insights Imaging,2015,6(2):203-215
[2]Fran?a LKL,Bitencourt AGV,Paiva HLS,et al. Role of magnetic resonance imaging in the planning of breast cancer treatment strategies:comparison with conventional imaging techniques[J]. Radiologia Brasileira,2017,50(2):76-81
[3]Assing MA,Patel BK,Karamsadkar N,et al. A comparison of the diagnostic accuracy of magnetic resonance imaging to axillary ultrasound in the detection of axillary nodal metastases in newly diagnosed breast cancer[J].Breast J,2017,23(6):647-655
[4]Chen X,He Y,Wang J,et al. Feasibility of using negative ultrasonography results of axillary lymph nodes to predict sentinel lymph node metastasis in breast cancer patients[J]. Cancer Med,2018,(1):1-7
[5]Peiqi W,Chunling L,Zaiyi L,et al. Value of mamography,CT and DCE-MRI in detecting axillary lymph node metastasis of breast cancer[J]. J South Med Univ,2016,36(4):493-499
[6]王怡,张欢,唐蕾,等.常规超声、钼靶和磁共振对腋窝淋巴结状态的诊断价值评估[J].中国超声医学杂志,2014,30(5):391-394
[7]Valente SA,Levine GM,Silverstein MJ,et al. Accuracy of predicting axillary lymph node positivity by physical examination,mammography,ultrasonography,and magnetic resonance imaging[J]. Ann Surg Oncol,2012,19:1825-1830
[8]叶莹莹,张扬,张海静.磁共振技术诊断乳腺癌腋窝淋巴转移的研究进展[J].实用医技杂志,2016,23(1):56-58
[9]van Nijnatten TJA,Ploumen EH,Schipper RJ,et al. Routine use of standard breast MRI compared to axillary ultrasound for differentiating between no,limited and advanced axillary nodal disease in newly diagnosed breast cancerpatients[J].EurJRadiol,2016,85(12):2288-2294
[10]刘鸿利,寒位,邹启桂,等. 3.0T MRI扩散加权成像表观扩散系数直方图与乳腺浸润性导管癌分子亚型的相关性研究[J].南京医科大学学报(自然科学版),2018,38(2):211-216
[11]彭徐辉.多层螺旋CT双期增强扫描对乳腺癌及早期淋巴结转移患者的诊断价值[J].实用癌症杂志,2016,31(2):277-299
[12]Lowes S,Leaver A,Cox K,et al. Evolving imaging techniques for staging axillary lymph nodes in breast cancer.[J]. Clinical Radiology,2018,73(4):396-409
[13]赵戈,樊菁,巫姜,等.多排螺旋CT对乳腺癌腋窝淋巴结的术前评估价值[J].四川医学,2017,38(12):1444-1447
[14]Hyun SJ,Kim EK,Moon HJ,et al. Preoperative axillary lymph node evaluation in breast cancer patients by breast magnetic resonance imaging(MRI):Can breast MRI exclude advanced nodal disease?[J]. European Society of Radiology,2016,26:3865-3873
[15]Zhang Y,Wang C,Xu Y,et al. Sensitivity,specificity and accuracy of ultrasound in diagnosis of breast cancer metastasis to the axillary lymph nodes in chinese patients[J]. Ultrasound in Med&Biol,2015,41(7):1835-1841
[16]Fornasa F,Nesoti M V,Bovo C,et al. Diffusion-weighted magnetic resonance imaging in the characterization of axillary lymph nodes in patients with breast cancer[J]. Journal of Magnetic Resonance Imaging,2012,36:858-864
[17]Kuijs V J,Moossdorff M,Schipper R J,et al. The role of MRI in axillary lymph node imaging in breast cancer patients:a systematic review[J]. Insights Imaging,2015,6(2):203-215