常规超声与弹性成像在乳腺癌腋窝淋巴结鉴别诊断中的价值

Value of conventional ultrasonography and elastography in diagnosis of axillary lymph nodes in breast cancer patients

摘要:

探讨常规超声与超声弹性成像在乳腺癌腋窝淋巴结中的应用价值。方法应用常规超声及弹性成像技术对79 例乳腺癌患者的80 个腋窝淋巴结进行检查，以病理结果作为对照并分析。结果79 例乳腺癌患者的80 个腋窝淋巴结中60 个恶性、20 个良性。恶性淋巴结形态分型以Ⅱ及Ⅲ型为主，血流分型以Ⅲ型为主；弹性评分以3～4 分为主；弹性应变率比值的阈值为2.42，常规超声诊断淋巴结转移的敏感性、特异性及准确性分别为53.3%、95.0%及63.4%，弹性评分诊断淋巴结转移的敏感性、特异性及准确性分别为93.3%、90.0%、及92.5%，弹性应变率比值诊断淋巴结转移的敏感性、特异性及准确性分别为91.7%、95.0%及91.2%。3 种检查方法诊断结果的准确性比较，差异有统计学意义（χ2=31.121，p <0.05）。结论弹性成像技术可作为评估淋巴结的有效方法，能够作为鉴别淋巴结良恶性的较好补充。

Abstract:

To discuss the value of conventional ultrasonography and elastography in diagnosis of axillary lymph nodes in breast cancer patients. Methods Conventional ultrasonography and elastography were applied to examine 80 axillary lymph nodes of 79 patients with breast cancer, the results were compared with histopathological outcomes. Results There were 60 malignant and 20 benign lymph nodes in the 79 breast cancer patients. In the malignant lymph nodes, the morphology was mainly type Ⅱand Ⅲ, the blood flow was mainly type Ⅲ, the elasticity score was primarily 3 and 4, the cut-off of ratio of elastic strain rate was 2.42. The sensitivity, specificity and accuracy of conventional ultrasonography for diagnosis of lymph node metastasis were 53.3%, 95.0% and 63.4% respectively, those of elastic score were 93.3%, 90.0% and 92.5%,those of elastic strain rate ratio were 91.7%, 95.0% and 91.2% respectively. There were significant differences in the accuracy of the diagnostic results among the three methods (χ2 = 32.121,p < 0.05). Conclusions Elastography can be used as an effective method to assess lymph node status. It is complementary to the conventional ultrasonography for the differential diagnosis of axillary lymph nodes in patients with breast cancer.