超声影像在乳腺癌腋窝淋巴结转移诊断中的临床应用价值
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摘要
目的探讨超声影像在乳腺癌腋窝淋巴结转移诊断中的临床应用价值。方法回顾性分析2008年1月～2017年7月在北京儿童医院顺义妇儿医院乳腺中心接受诊疗的682例新发浸润性乳腺癌患者的临床资料,通过超声影像中腋窝淋巴结的形态及皮质厚度,将患者分为腋窝淋巴结无异常组419例和异常组263例。异常组患者接受细针针吸细胞学检查,发现癌细胞者进入治疗;未发现明显癌细胞者与无异常组患者均接受前哨淋巴结活检。超声诊断淋巴结异常的263例中有215例经病理诊断证实为阳性,超声诊断淋巴结无异常的419例中有99例经病理诊断证实为阳性。以组织病理学诊断结果为金标准,分析腋窝淋巴结超声分类标准的诊断价值,采用Kappa检验评价超声和病理对腋窝淋巴结状态诊断的一致性,采用Pearsonχ~2检验探索腋窝淋巴结转移相关因素。结果超声影像评价腋窝淋巴结转移的灵敏度、特异度、阳性预测值及阴性预测值依次为68.5%、87.0%、81.7%、76.4%;超声和病理对腋窝淋巴结状态诊断的一致性较好,Kappa值为0.561。腋窝淋巴结转移与家族史具有相关性(P<0.05),与年龄、月经状态、分子分型无明显相关性(P>0.05)。结论超声影像在乳腺癌腋窝淋巴结转移诊断中具有较高的临床应用价值。腋窝淋巴结转移与患者家族史有相关性,与年龄、月经状态、分子分型无明显相关性。
Objective To evaluate the clinical value of ultrasonography in the diagnosis of axillary lymph node metastasis in breast cancer. Methods Clinical data of 682 primary invasive breast cancer patients who underwent treatment in Breast Center, Shunyi Women′s and Children′s Hospital of Beijing Children′s Hospital from January 2008 to July 2017 were studied retrospectively. Patients were divided into normal group(n = 419) and abnormal group(n = 263) depending on the morphology and cortical thickness of axillary lymph nodes through ultrasonography. The patients in the abnormal group underwent ultrasound guided fine needle aspiration(FNA). Except for patients who were diagnosed with positive axillary lymph nodes, the others underwent sentinel lymph node biopsy(SLNB). Two hundred and fifteen of the263 cases which had abnormal lymph node diagnosis were confirmed positive by histopathology, and 99 of 419 cases which had normal lymph node diagnosis were confirmed positive by histopathology. Histopathological diagnosis was set as gold standard, the value of ultrasound classification for axillary lymph nodes was evaluated. Kappa analysis was used to evaluate the consistency of ultrasonography and histopathology. Pearson χ~2 test was used to analyze the related factors of axillary lymph node metastasis. Results The sensitivity, specificity, positive and negative predictive value of ultrasonography in the diagnosis of axillary lymph node metastasis in breast cancer was 68.5%, 87.0%, 81.7%, 76.4% respectively. The ultrasonography and histopathology was in good coincidence, and the value of Kappa was 0.561. The axillary lymph node metastasis in breast cancer was related to family history of the patients(P < 0.05), but not significantly related to age, menopausal status or subtype classification(P > 0.05). Conclusion Ultrasonography has a higher clinical practical diagnostic value for axillary lymph node metastasis in breast cancer. The axillary lymph node metastasis is related to family history, but not significantly related to age, menopausal status or subtype classification.
Objective To evaluate the clinical value of ultrasonography in the diagnosis of axillary lymph node metastasis in breast cancer. Methods Clinical data of 682 primary invasive breast cancer patients who underwent treatment in Breast Center, Shunyi Women′s and Children′s Hospital of Beijing Children′s Hospital from January 2008 to July 2017 were studied retrospectively. Patients were divided into normal group(n = 419) and abnormal group(n = 263) depending on the morphology and cortical thickness of axillary lymph nodes through ultrasonography. The patients in the abnormal group underwent ultrasound guided fine needle aspiration(FNA). Except for patients who were diagnosed with positive axillary lymph nodes, the others underwent sentinel lymph node biopsy(SLNB). Two hundred and fifteen of the263 cases which had abnormal lymph node diagnosis were confirmed positive by histopathology, and 99 of 419 cases which had normal lymph node diagnosis were confirmed positive by histopathology. Histopathological diagnosis was set as gold standard, the value of ultrasound classification for axillary lymph nodes was evaluated. Kappa analysis was used to evaluate the consistency of ultrasonography and histopathology. Pearson χ~2 test was used to analyze the related factors of axillary lymph node metastasis. Results The sensitivity, specificity, positive and negative predictive value of ultrasonography in the diagnosis of axillary lymph node metastasis in breast cancer was 68.5%, 87.0%, 81.7%, 76.4% respectively. The ultrasonography and histopathology was in good coincidence, and the value of Kappa was 0.561. The axillary lymph node metastasis in breast cancer was related to family history of the patients(P < 0.05), but not significantly related to age, menopausal status or subtype classification(P > 0.05). Conclusion Ultrasonography has a higher clinical practical diagnostic value for axillary lymph node metastasis in breast cancer. The axillary lymph node metastasis is related to family history, but not significantly related to age, menopausal status or subtype classification.
引文
[1]巫姜,赵戈,崔风强,等.前哨淋巴结活检联合术前超声在老年乳腺癌腋窝淋巴结清扫中的价值[J].现代肿瘤医学,2016,24(4):551-554.
[2]沈恩超,栗翠英,王聪,等.术前超声造影检查结合粗针穿刺活检对乳腺癌腋窝淋巴结评估的临床意义[J].中华实验外科杂志,2017,34(2):285-287.
[3]霍苓,严昆,张晖,等.原发性乳腺癌阳性腋窝淋巴结超声影像诊断标准探讨[J].中华医学杂志,2012,92(10):672-674.
[4]Perou CM,Srlie T,Eisen MB,et al.Molecular portraits of human breast tumours[J].Nature,2000,406(6797):747-752.
[5]Fan L,Strasser-Weippl K,Li JJ,et al.Breast cancer in China[J].Lancet Oncol,2014,15(7):e279-e289.
[6]Plecha D,Bai S,Patterson H,et al.Improving the accuracy of axillary lymph node surgery in breast cancer with ultrasound-guided wire localization of biopsy proven metastatic lymph nodes[J].Ann Surg Oncol,2015,22(13):4241-4246.
[7]Husted Madsen A,Haugaard K,Soerensen J,et al.Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection:a study from the danish breast cancer cooperative group[J].Breast,2008,17(2):138-147.
[8]Ashikaga T,Krag DN,Land SR,et al.Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection[J].J Surg Oncol,2010,102(2):111-118.
[9]Liu CQ,Guo Y,Shi JY,et al.Late morbidity associated with a tumour-negative sentinel lymph node biopsy in primary breast cancer patients:a systematic review[J].Eur J Cancer,2009,45(9):1560-1568.
[10]李慧芳,刘景萍,郑薇薇,等.高频彩色多普勒超声及弹性成像在乳腺癌腋淋巴结转移中的应用价值[J].山西医药杂志,2016,45(5):510-513.
[11]杨志,李宁,廖光星,等.乳腺癌原发灶弥散加权成像在预测腋窝淋巴结转移中的应用价值[J].郑州大学学报:医学版,2017,52(4):448-451.
[12]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范[J].中国癌症杂志,2015,25(9):692-754.
[13]Zhang F,Zhang J,Meng QX,et al.Ultrasound combined with fine needle aspiration cytology for the assessment of axillary lymph nodes in patients with early stage breast cancer[J].Medicine(Baltimore),2018,97(7):e9855.
[14]Turtle TM,Zogakis TG,Dunst CM,et al.A review oftechnical aspects of sentinel lymph node idetifieation for breast cancer[J].J Am Coil Surg,2002,195(2):261-268.
[15]Omoto K,Matsunaga H,Take N,et al.Sentinel node detection method using contrast-enhanced ultrasonography with sonazoid in breast cancer:preliminary clinical study[J].Ultrasound Med Biol,2009,35(8):1249-1256.
[16]汪满金,俸瑞发.乳腺癌前哨淋巴结活检的研究进展[J].中国普外基础与临床杂志,2014,21(12):1587-1592.
[17]陈登峰.前哨淋巴结活检对早期乳腺癌患者腋窝淋巴结转移状况的预测[J].中国普通外科杂志,2014,23(11):1590-1592.
[18]Jones T,Neboori H,Wu H,et al.Are breast cancer subtypes prognostic for nodal involvement and associated with clinicopathologic features at presentation in early—stage breast cancer?[J].Ann Surg Oncol,2013,20(9):2866-2872.
[19]辛灵,陈路增,张虹,等.乳腺癌腋窝淋巴结转移的超声诊断价值及临床病理相关性分析[J].中华医学外科杂志,2014,52(12):924-928.
[20]姜朋丽,付彤.不同分期乳腺癌患者分子分型与腋窝淋巴结转移的关系及其临床意义[J].吉林大学学报:医学版,2016,42(1):144-148.
[21]李艺,王燕.经皮超声造影提示前哨淋巴结性质对腋窝淋巴结良恶性评估的价值[J].上海交通大学学报:医学版,2015,35(9):1320.
[2]沈恩超,栗翠英,王聪,等.术前超声造影检查结合粗针穿刺活检对乳腺癌腋窝淋巴结评估的临床意义[J].中华实验外科杂志,2017,34(2):285-287.
[3]霍苓,严昆,张晖,等.原发性乳腺癌阳性腋窝淋巴结超声影像诊断标准探讨[J].中华医学杂志,2012,92(10):672-674.
[4]Perou CM,Srlie T,Eisen MB,et al.Molecular portraits of human breast tumours[J].Nature,2000,406(6797):747-752.
[5]Fan L,Strasser-Weippl K,Li JJ,et al.Breast cancer in China[J].Lancet Oncol,2014,15(7):e279-e289.
[6]Plecha D,Bai S,Patterson H,et al.Improving the accuracy of axillary lymph node surgery in breast cancer with ultrasound-guided wire localization of biopsy proven metastatic lymph nodes[J].Ann Surg Oncol,2015,22(13):4241-4246.
[7]Husted Madsen A,Haugaard K,Soerensen J,et al.Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection:a study from the danish breast cancer cooperative group[J].Breast,2008,17(2):138-147.
[8]Ashikaga T,Krag DN,Land SR,et al.Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection[J].J Surg Oncol,2010,102(2):111-118.
[9]Liu CQ,Guo Y,Shi JY,et al.Late morbidity associated with a tumour-negative sentinel lymph node biopsy in primary breast cancer patients:a systematic review[J].Eur J Cancer,2009,45(9):1560-1568.
[10]李慧芳,刘景萍,郑薇薇,等.高频彩色多普勒超声及弹性成像在乳腺癌腋淋巴结转移中的应用价值[J].山西医药杂志,2016,45(5):510-513.
[11]杨志,李宁,廖光星,等.乳腺癌原发灶弥散加权成像在预测腋窝淋巴结转移中的应用价值[J].郑州大学学报:医学版,2017,52(4):448-451.
[12]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范[J].中国癌症杂志,2015,25(9):692-754.
[13]Zhang F,Zhang J,Meng QX,et al.Ultrasound combined with fine needle aspiration cytology for the assessment of axillary lymph nodes in patients with early stage breast cancer[J].Medicine(Baltimore),2018,97(7):e9855.
[14]Turtle TM,Zogakis TG,Dunst CM,et al.A review oftechnical aspects of sentinel lymph node idetifieation for breast cancer[J].J Am Coil Surg,2002,195(2):261-268.
[15]Omoto K,Matsunaga H,Take N,et al.Sentinel node detection method using contrast-enhanced ultrasonography with sonazoid in breast cancer:preliminary clinical study[J].Ultrasound Med Biol,2009,35(8):1249-1256.
[16]汪满金,俸瑞发.乳腺癌前哨淋巴结活检的研究进展[J].中国普外基础与临床杂志,2014,21(12):1587-1592.
[17]陈登峰.前哨淋巴结活检对早期乳腺癌患者腋窝淋巴结转移状况的预测[J].中国普通外科杂志,2014,23(11):1590-1592.
[18]Jones T,Neboori H,Wu H,et al.Are breast cancer subtypes prognostic for nodal involvement and associated with clinicopathologic features at presentation in early—stage breast cancer?[J].Ann Surg Oncol,2013,20(9):2866-2872.
[19]辛灵,陈路增,张虹,等.乳腺癌腋窝淋巴结转移的超声诊断价值及临床病理相关性分析[J].中华医学外科杂志,2014,52(12):924-928.
[20]姜朋丽,付彤.不同分期乳腺癌患者分子分型与腋窝淋巴结转移的关系及其临床意义[J].吉林大学学报:医学版,2016,42(1):144-148.
[21]李艺,王燕.经皮超声造影提示前哨淋巴结性质对腋窝淋巴结良恶性评估的价值[J].上海交通大学学报:医学版,2015,35(9):1320.