B超引导细针穿刺活检术在乳腺癌腋窝淋巴结转移中的诊断价值
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摘要
目的探讨B超引导下细针穿刺活检术(UG-FNAB)在乳腺癌腋窝淋巴结转移(ALNM)中的诊断价值。方法纳入97例乳腺癌患者,均行B超及UG-FNAB检查。以术后病理诊断为金标准,评价B超及B超引导下细针穿刺腋窝淋巴结活检术在乳腺癌ALNM中的诊断效能。结果 UG-FNAB诊断ALNM的敏感度、特异度、准确度、阳性与阴性预测值分别为57. 6%、100. 0%、85. 6%、100. 0%、82. 1%,与病理诊断结果的一致性一般(Kappa值=0. 642,P <0. 001)。B超与UG-FNAB诊断乳腺癌ALNM的受试者工作特征曲线下面积分别为0. 644、0. 727,UG-FNAB的诊断效能优于B超检查(P <0. 05)。结论相比于单纯的B超检查,UG-FNAB可以提高ALNM的诊断准确度。
Objective To investigate the diagnostic value of ultrasound-guided fine needle aspiration biopsy( UG-FNAB) for axillary lymph node metastasis( ALNM) of breast cancer. Methods Ninety-seven patients with breast cancer were enrolled,and performed with ultrasonography or UG-FNAB. Efficacy of these two methods in diagnosing ALNM of breast cancer was assessed with postoperative pathological diagnosis as the golden standard. Results The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of UG-FNAB in diagnosing ALNM of breast cancer were 57. 6%,100. 0%,85. 6%,100. 0% and 82. 10%,respectively,and its consistency with pathological diagnosis was moderate( Kappa value,0. 642,P < 0. 001). The areas under the receiver operating characteristic curve of ultrasonography and UG-FNAB for diagnosing ALNM of breast cancer were 0. 644 and 0. 727,respectively,and UG-FNAB was superior to ultrasonography in diagnostic efficacy( P < 0. 05). Conclusion Compared with isolated ultrasonography,UG-FNAB can improve the diagnostic accuracy for ALNM of breast cancer.
Objective To investigate the diagnostic value of ultrasound-guided fine needle aspiration biopsy( UG-FNAB) for axillary lymph node metastasis( ALNM) of breast cancer. Methods Ninety-seven patients with breast cancer were enrolled,and performed with ultrasonography or UG-FNAB. Efficacy of these two methods in diagnosing ALNM of breast cancer was assessed with postoperative pathological diagnosis as the golden standard. Results The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of UG-FNAB in diagnosing ALNM of breast cancer were 57. 6%,100. 0%,85. 6%,100. 0% and 82. 10%,respectively,and its consistency with pathological diagnosis was moderate( Kappa value,0. 642,P < 0. 001). The areas under the receiver operating characteristic curve of ultrasonography and UG-FNAB for diagnosing ALNM of breast cancer were 0. 644 and 0. 727,respectively,and UG-FNAB was superior to ultrasonography in diagnostic efficacy( P < 0. 05). Conclusion Compared with isolated ultrasonography,UG-FNAB can improve the diagnostic accuracy for ALNM of breast cancer.
引文
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[15]赵一博,白玲,唐英,等.超声引导腋窝淋巴结穿刺活检在诊断乳腺癌腋窝淋巴结转移中的临床价值研究[J].军事医学,2015,39(7):541-545.
[16]Britton PD,Goud A,Godward S,et al. Use of ultrasoundguided axillary node core biopsy in staging of early breast cancer[J]. Eur Radiol,2009,19(3):561-569.
[2]段纪俊,严亚琼,杨念念,等.中国恶性肿瘤发病与死亡的国际比较分析[J].中国医学前沿杂志(电子版),2016,8(7):17-23.
[3]Veronesi U,Paganelli G,Viale G,et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer:update of a randomised controlled study[J]. Lancet Oncol,2006,7(12):983-990.
[4]Intra M,Rotmensz N,Veronesi P,et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast:the experience of the European institute of oncology on 854 patients in 10 years[J]. Ann Surg,2008,247(2):315-319.
[5]阮雅君,潘登,祝杭燕,等.超声引导下细针穿刺对乳腺癌及腋下淋巴结转移的诊断价值[J].中国慢性病预防与控制,2018,26(10):763-766.
[6]Deurloo EE,Tanis PJ,Gilhuijs KG,et al. Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer[J]. Eur J Cancer,2003,39(8):1 068-1 073.
[7]Gruber I,Henzel M,Schnfisch B,et al. Prediction of nonsentinel lymph node metastases after positive sentinel lymph nodes using nomograms[J]. Anticancer Res,2018,38(7):4 047-4 056.
[8]Gur AS,Unal B,Ozbek U,et al. Validation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study[J]. Eur J Surg Oncol,2010,36(1):30-35.
[9]Klar M,Foeldi M,Markert S,er al. Good prediction of the likelihood for sentinel lymph node metastasis by using the MSKCC nomogram in a German breast cancer population[J]. Ann Surg Oncol,2009,16(5):1 136-1 142.
[10]Esen G,Gurses B,Yilmaz MH,et al. Gray scale and power doppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes[J].Eur Radiol,2005,15(6):1 215-1 223.
[11]Somasundar P,Gass J,Steinhoff M,et al. Role of ultrasoundguided axillary fine-needle aspiration in the management of invasive breast cancer[J]. Am J Surg,2006,192(4):458-461.
[12]Leenders MW,Broeders M,Croese C,et al. Ultrasound and fine needle aspiration cytology of axillary in breast cancer.To do or not to do?[J]. Breast,2012,21(4):578-583.
[13]Boivin L,Diguisto C,Chas M,et al. Outcomes of patients with breast cancer in function of their body mass index[J].Gynecol Obstet Fertil Senol,2017,45(4):215-223.
[14]杨丽,张春霞,王文超.人表皮生长因子受体-2与细胞增殖抗原Ki67在乳腺癌中表达及临床意义[J].中华实用诊断与治疗杂志,2015,29(2):166-168.
[15]赵一博,白玲,唐英,等.超声引导腋窝淋巴结穿刺活检在诊断乳腺癌腋窝淋巴结转移中的临床价值研究[J].军事医学,2015,39(7):541-545.
[16]Britton PD,Goud A,Godward S,et al. Use of ultrasoundguided axillary node core biopsy in staging of early breast cancer[J]. Eur Radiol,2009,19(3):561-569.