乳腺癌超声征象与淋巴结转移关系的单因素及多因素分析

目的 探讨乳腺癌原发肿块、腋窝淋巴结超声征象与淋巴结转移的关系.方法 回顾性分析146例乳腺癌患者151个原发肿块(66个伴淋巴结转移,85个未转移)及腋窝淋巴结声像图特征,与病理结果对照,用单因素(X~2检验)和多因素(Logistic回归)分析各声像图特征与淋巴结转移的关系,对超声征象和病理的吻合度进行k系数检验.对乳腺癌中提示淋巴结转移的超声征象与有转移的腋窝淋巴结征象进行相关分析.结果 单因素和多因素分析显示肿块最大直径、血流分级及淋巴结最大皮质厚度与淋巴结转移关系密切(X~2=37.939、13.153、69.128,OR=6.632、3.714、35.442,P均<0.01),且与病理结果有较好的吻合度(k=0.501、0.690、0.673),能较准确地判断腋窝淋巴结转移.肿块最大直径、血流分级与淋巴结最大皮质厚度有较好相关性(X2=40.132、33.128,P均<0.01).肿块距体表距离以及间质纤维结构改变等征象对判断乳腺癌淋巴结转移有一定提示作用.结论 采用单因素及多因素分析乳腺癌超声征象能为术前准确判断腋窝淋巴结转移提供重要的依据.     

Axillary Lymph Node Sonographic Features and Breast Tumor Characteristics as Predictors of Malignancy: A Nomogram to Predict Risk

The purpose of this study was to build a mathematical model to predict the probability of axillary lymph node metastasis based on the ultrasonographic features of axillary lymph nodes and the tumor characteristics. We included 74 patients (75 axillae) with invasive breast cancer who underwent axillary ultrasonography ipsilateral to the tumor and fine-needle aspiration of one selected lymph node. Lymph node pathology results from sentinel lymph node biopsy or surgical dissection were correlated with lymph node ultrasonographic data and with the cytologic findings of fine-needle aspiration. Our mathematical model of prediction risk of lymph node metastasis included only pre-surgical data from logistic regression analysis: lymph node cortical thickness (p = 0.005), pre-surgical tumor size (p = 0.030), menopausal status (p = 0.017), histologic type (p = 0.034) and tumor location (p = 0.011). The area under the receiver operating characteristic curve of the model was 0.848, reflecting an excellent discrimination of the model. This nomogram may assist in the choice of the optimal axillary approach.     

超声联合免疫组织化学指标预测新辅助化疗后乳腺癌转移性腋窝淋巴结病理完全缓解

目的 观察超声联合免疫组织化学指标预测新辅助化疗(NACT)后乳腺癌转移性腋窝淋巴结病理完全缓解(pCR)的价值.方法 纳入155例接受NACT的乳腺癌伴腋窝淋巴结转移患者,根据腋窝淋巴结清扫(ALND)术后病理结果将其分为pCR组(n=59)及非pCR组(n=96);比较2组NACT前免疫组织化学指标及乳腺癌病灶及腋...     

小乳腺癌超声直接和间接征象与腋窝淋巴结转移关系的Logistic回归分析

目的探讨小乳腺癌（最大径均42．0cm）超声直接征象和间接征象与腋窝淋巴结转移的关系。方法对65例（65个肿块）乳腺癌患者的（23例伴腋窝淋巴结转移）术前超声声像图表现进行分析,以病理表现为基础将超声图像分为直接征象和间接征象。直接征象包括：（1）肿块形态不规则;（2）小分叶;（3）边缘毛刺;（4）内部回声不均匀;（5）内部微钙化;（6）后方回声衰减;（7）纵横比30．71;（8）血流分级Ⅱ～Ⅲ级;（9）内部穿支血管;（10）最大血流速度Vmax315cm／s;（11）阻力指数R130．7;（12）速升速降型血流频谱。间接征象包括：（1）肿块周边高回声晕;（2）乳腺间质内纤维结构（浅筋膜、深筋膜及Cooper韧带）的模糊或中断;（3）腋窝淋巴结肿大（长短径比〈2．0、最大皮质厚度33．0mm、皮髓质比≥1．0以及血流类型）。以病理诊断淋巴结转移为因变量,小乳腺癌各超声直接和问接征象为白变量,建立Logistic回归模型,用ROC曲线评价Logistic模型的预报能力。结果小乳腺癌直接征象中内部微钙化、血流分级Ⅱ～Ⅲ级和间接征象中浅筋膜的改变、淋巴结最大皮质厚度33．0mm进入方程,血流分级Ⅱ～Ⅲ级和淋巴结最大皮质厚度≥3．0mm对预测腋窝淋巴结转移有统计学意义（OR=33．246、99．579,P=0．005、0．001）,ROC曲线下面积分别为0．909±0．043和0．923±0．044,P=0．000、0．000。微钙化和浅筋膜的改变对预测腋窝淋巴结转移无统计学意义（OR=12．036、19．406,P=0．098、0．066）。结论小乳腺癌直接征象中血流分级Ⅱ一Ⅲ级和间接征象中淋巴结最大皮质厚度33．0mm与腋窝淋巴结转移关系密切,对术前预测小乳腺癌淋巴结是否转移具有重要价值。     

高频彩超预测乳腺癌淋巴结转移的相关因素探讨

目的分析乳腺癌患者腋下淋巴结转移（LNM）的相关因素,以获得超声预测乳腺癌患者腋下淋巴结转移的指标。方法分析我院171例乳腺癌患者的原发灶和腋LN的超声图像。观察原发灶的位置、最大径、肿瘤内部的血流丰富程度分级（0～级）、腋下可探及淋巴结的个数。全部患者均进行乳房改良根治术,以腋LN清扫的病理结果作为金标准,对与LNM相关的影像及临床因素进行单因素及多因素分析（Logistic回归）,并利用受试者工作特性（ROC）曲线评价诊断指标。结果171例乳腺癌患者的超声观察指标单因素分析结果显示,原发灶的最大径、超声可探及的淋巴结个数,差异有统计学意义（P=0.000）。将统计的指标进行多因素分析,原发灶的最大径线与超声可探及的淋巴结数均进入方程。利用ROC曲线评价肿块最大径线的诊断价值,结果显示,随着预测淋巴结转移的肿瘤最大径线值的增大,其敏感性降低,而特异性增大,肿瘤最大径为20mm、24.5mm、31.5mm时,其敏感性分别为75.3%、63.0%、32.5%,而特异性分别为55.7%、73.9%、90.0%。结论对乳腺癌患者进行腋下淋巴结超声扫查,综合考虑原发灶最大径线与可探及的腋下淋巴结数,将有助于提高超声诊断腋LNM的正确率,较为准确地判断淋巴结的状态。     

高频超声对乳腺癌内乳淋巴结转移的诊断价值

目的探讨乳腺癌内乳淋巴结(internal mammary lymph node,IMLN)转移的超声图像特点及危险因素。方法回顾性分析2010年3月至2020年5月河北医科大学第四医院收治的新发乳腺癌患者296例,IMLN以病理结果为诊断标准,分为转移组(236例)和未转移组(60例),应用卡方检验、独立样本t检验分析IMLN转移的声像图特点及与转移相关的因素,ROC曲线分析IMLN长径、厚径、皮质增厚阈值及其诊断转移的敏感性、特异性。采用单因素及多因素Logistic分析确定IMLN转移的危险因素。结果①IMLN超声表现分为四型:正常结构型,皮质增厚型,淋巴结门结构不清型和结节状软组织增厚型。②两组中,IMLN长径、厚径、个数及淋巴门结构类型差异有统计学意义(均P<0.05),而IMLN长径/厚径比值、IMLN血供差异无统计学意义(均P>0.05)。③诊断转移的IMLN长径阈值为10.5 mm,ROC曲线下面积(AUC)为0.825,敏感性、特异性分别为58.5%、93.3%;厚径阈值为4.5 mm,AUC为0.790,敏感性、特异性分别为66.9%、75.0%;长径联合结构类型、厚径联合结构类型诊断的敏感性及特异性分别为56.3%、93.3%及64.8%、81.7%;皮质厚度阈值为1.9 mm,诊断敏感性及特异性分别为91.9%、86.7%。④IMLN转移的危险因素:单因素分析提示乳腺肿物长径与体积、腋窝转移淋巴结长径、腋窝淋巴结及锁骨下淋巴结转移两组比较差异有统计学意义(均P<0.05);多因素分析提示乳腺肿物长径及腋窝淋巴结转移是IMLN转移的独立危险因素。结论转移的IMLN多表现为无淋巴门结构或者皮质增厚(≥1.9 mm),且IMLN多发有助于诊断转移。超声能较好地评估乳腺癌IMLN转移,IMLN长径联合结构类型的诊断效能更高。IMLN转移的独立危险因素为乳腺肿物长径及腋窝淋巴结转移。     

Ultrasound-Guided Fine-Needle Aspiration of Non-palpable and Suspicious Axillary Lymph Nodes with Subsequent Removal after Tattooing: False-Negative Results and Concordance with Sentinel Lymph Nodes

Ultrasonography-guided fine-needle aspiration (US-guided FNA) for axillary lymph nodes (ALNs) is currently used with various techniques for the initial staging of breast cancer and tagging of ALNs. With the implementation of the tattooing of biopsied ALNs, the rate of false-negative results of US-guided FNA for non-palpable and suspicious ALNs and concordance with sentinel lymph nodes were determined by node-to node analyses. A total of 61 patients with breast cancer had negative results for metastasis on US-guided FNA of their non-palpable and suspicious ALNs. The biopsied ALNs were tattooed with an injection of 1–3 mL Charcotrace (Phebra, Lane Cove West, Australia) ink and removed during sentinel lymph node biopsy or axillary dissection. We determined the rate of false-negative results and concordance with the sentinel lymph nodes by a retrospective review of surgical and pathologic findings. The association of false-negative results with clinical and imaging factors was evaluated using logistic regression. Of the 61 ALNs with negative results for US-guided FNA, 13 (21%) had metastases on final pathology. In 56 of 61 ALNs (92%), tattooed ALNs corresponded to the sentinel lymph nodes. Among the 5 patients (8%) without correspondence, 1 patient (2%) had 2 metastatic ALNs of 1 tattooed node and 1 sentinel lymph node. In multivariate analysis, atypical cells on FNA results (odds ratio = 20.7, p = 0.040) was independently associated with false-negative FNA results. False-negative ALNs after US-guided FNA occur at a rate of 21% and most of the tattooed ALNs showed concordance with sentinel lymph nodes.     

高频彩色多普勒超声诊断乳腺癌腋窝淋巴结转移的价值

目的探讨高频彩色多普勒超声在乳腺癌腋窝淋巴结转移诊断中的应用价值。方法对266例乳腺癌患者的腋窝淋巴结行术前超声检查,对超声检出的152例腋窝淋巴结与术后病理结果对照,将其分为淋巴结转移组（93例）与淋巴结无转移组（59例）,并对超声所显示的两组淋巴结的最大径、纵横比、皮髓比及血流分布类型行对比分析,并运用受试者工作特性（ROC）曲线进行评价。结果淋巴结转移组93例与淋巴结无转移组59例患者的淋巴结最大径分别为（18．9±6．7）mm及（19．6±7．2）mm,差异无统计学意义（P〉0．05）;而淋巴结转移组淋巴结的纵横比及皮髓比的中位数值分别为1．5（1～2．6）与2．0（0．8～4）,与淋巴结无转移组的1．9（1～4．5）与0．5（0．2～2）比较差异均有统计学意义（均P〈0．05）;淋巴结转移组淋巴结血流分布以周围型及混合型居多,分别为54．5％（18／33）与30．3％（10／33）;淋巴结无转移组淋巴结血流分布则以中央型居多,占63．2％（12／19）。ROC曲线分析显示：取淋巴结纵横比≤1．8对诊断淋巴结转移的敏感度及特异度分别高达62．4％与62．7％;取淋巴结皮髓比≥1．0对诊断淋巴结转移的敏感度及特异度分别高达75．3％与86．4％。结论高频彩色多普勒超声观察乳腺癌腋窝淋巴结形态,并取淋巴结的纵横比≤1．8和（或）皮髓比≥1．0进行分析,可提高乳腺癌腋窝淋巴结转移的诊断率,值得深入探讨。     

Lymph Node Predictive Model with in Vitro Ultrasound Features for Breast Cancer Lymph Node Metastasis

Ultrasound diagnosis of axillary lymph nodes has the advantages of ease, convenience and low cost; however, most previous studies evaluated lymph node metastasis of the entire axilla rather than the association between the ultrasound features of a single lymph node and its pathology. This prospective study was performed to explore the ultrasound features of lymph nodes observed in bionic medium in vitro and to develop a lymph node-specific model for prediction of metastasis based on analysis of the association between the ultrasound features and pathology of each lymph node. From November 1, 2017 to December 19, 2017, 373 nodes (54 patients) were enrolled into the modeling group; from December 20, 2017 to January 12, 2018, 139 lymph nodes (22 patients) were enrolled into the validation group. Lymph nodes from sentinel lymph node biopsy or axillary lymph node dissection were enrolled. Individual lymph nodes were placed in bionic medium and observed separately using ultrasound. Traditional ultrasound features of metastatic nodes (long axis, short axis, cortical thickness and hilum loss) were recorded, and the longitudinal-to-transverse axis ratio (L/T) and cortical proportion were calculated. Pathologic results specific to each lymph node were recorded. On the basis of two-level binary logistic regression, independent predictors of lymph node metastasis in the modeling group were lymph node long axis (p = 0.004), short axis (p < 0.001), L/T (p = 0.006), cortical thickness (p = 0.001) and hilum loss (p < 0.001). When analysis was done at the node level, the areas under the curve of the modeling and validation groups were 0.97 and 0.75, respectively. When validation was done at the patient level, the areas under the curve of the modeling and validation groups were 0.96 and 0.93, respectively. The model for prediction of metastasis based on the ultrasound features and pathology of each lymph node is of good predictive value for lymph node metastasis.     

Evaluation of Axillary Lymph Nodes in Breast Cancer Patients with Atopic Dermatitis

This study assessed the diagnostic accuracy of ultrasound in detecting axillary lymph node metastases in women with breast cancer and atopic dermatitis. We retrospectively reviewed the records of 91 breast cancer patients with a history of atopic dermatitis and compared the dimensions of the lymph nodes on ultrasonographic images of women with and without lymph node metastases diagnosed using histology. Using a major-axis length of ≥5 mm, a short-axis length of ≥5 mm and a cortical thickness of ≥2.3 mm as the criteria for diagnosing axillary lymph node metastases, the specificity was 12.7%, 41.3% and 58.7%, respectively. The low specificity of the ultrasound criteria makes ultrasound unsuitable for diagnosing axillary lymph nodes metastases in breast cancer patients with atopic dermatitis.     

超声造影诊断乳腺癌不同分子分型腋窝淋巴结转移的价值

目的 探讨CEUS对乳腺癌不同分子分型腋窝淋巴结转移的诊断价值。 方法 对女性乳腺癌患者89例,术前于肿瘤周围皮下注射超声造影剂,探查前哨淋巴结并标记,与术后免疫组织化学分子分型结果进行对照。 结果 乳腺癌Luminal B型腋窝淋巴结转移率最高(69.57%),其次为HER-2型(55.00%)和三阴型(42.86%),Luminal A型转移率最低(28.00%)。CEUS判断腋窝淋巴结转移的敏感度为84.09%(37/44),特异度为86.67%(39/45)。 结论 CEUS对于诊断乳腺癌不同分子分型腋窝淋巴结转移具有一定价值。     

常规超声阴性乳腺癌的腋窝淋巴结超声影像分析

目的总结并分析常规超声在阴性乳腺癌腋窝淋巴结评估中的作用。方法对在我院常规超声阴性的73例乳腺癌患者的术前腋窝磁共振、钼靶、超声检查结果进行分析,并与病理结果进行对照。结果73例病例中,导管原位癌20例,浸润性导管癌43例,浸润性小叶癌2例,其他8例。腋窝淋巴结有转移病例15例,无转移58例。磁共振诊断腋窝转移性淋巴结灵敏度60.0%、特异度63.8%、准确率63.0%。钼靶分别为46.7%、94.8%、84.9%。常规超声分别为60.0%、98.3%、90.4%。结论常规超声阴性乳腺癌中,腋窝淋巴结具有一定的转移比例,在灵敏度上常规超声与磁共振相当,优于钼靶;在特异度和准确率上常规超声均优于磁共振和钼靶。     

In vitro B-mode ultrasonographic criteria for diagnosing axillary lymph node metastasis of breast cancer.

Axillary lymph node status is an important factor for staging and treatment planning in breast cancer. Our study was performed in vitro on a node-by-node basis to evaluate the ability of B-mode ultrasonographic images to distinguish metastatic from nonmetastatic nodes. Immediately prior to histologic examination, individual dissected axillary nodes were scanned in a water bath using a 10 MHz B-mode ultrasonographic transducer. Four B-mode features (size, circularity, border demarcation, and internal echo) were evaluated for their ability to distinguish metastatic from nonmetastatic lymph nodes. Lymph node metastasis was indicated by (1) a large size (i.e., a length of the longest axis of 10 mm or greater); (2) a circular shape (i.e., the ratio of the shortest axis to the longest axis between 0.5 and 1.0); (3) a sharply demarcated border compared with surrounding fatty tissue; and (4) a hypoechoic internal echo, with obliteration of the fatty hilum. The sensitivity and specificity were compared for all combinations of features. We examined 84 histologically characterized axillary nodes from 27 breast cancer patients, including 64 nonmetastatic and 20 metastatic nodes. Of the criteria cited, circular shape was the best single feature for distinguishing metastatic from nonmetastatic nodes (sensitivity, 65%; specificity, 73%). The best combination of sensitivity (85%) and specificity (73%) was obtained using the criterion that a lymph node contained cancer when at least three positive features were present. The present in vitro study demonstrated that the sensitivity and specificity of B-mode ultrasonography for diagnosing lymph node metastasis were lower than 90%. Therefore, B-mode ultrasonography may not be an optimal noninvasive screening method for diagnosing axillary lymph node metastasis in breast cancer patients, particularly under in vivo clinical conditions.     

磁共振间质淋巴造影诊断乳腺癌腋窝淋巴结转移

目的 探讨MR间质淋巴造影诊断乳腺癌腋窝淋巴结转移的价值。方法 对36例浸润性乳腺癌患者于术前行MR间质淋巴造影检查,观察前哨淋巴结（SLN）、乳腺引流淋巴管情况;术中在美蓝引导下行SLN活检;根据活检结果评价MR间质淋巴造影显示 SLN的效果及诊断腋窝淋巴结转移敏感度、特异度及准确率。结果 MR间质淋巴造影显示每例患者SLN平均（1.33±0.53）枚,美蓝为示踪剂显示SLN 平均（1.19±0.47）枚,差异无统计学意义（t=1.711,P=0.096）。MR间质淋巴造影判断淋巴结转移阳性10例,术后病理结果全部为淋巴结转移;淋巴造影阴性25例,24例术后病理结果未见转移,1例为假阴性。MR间质淋巴造影诊断乳腺癌患者淋巴转移的敏感度为90.91%（10/11）,特异度为100%（24/24）,准确率为97.14%（34/35）。结论 MR间质淋巴造影能有效、可靠地显示乳腺癌引流区域淋巴管、淋巴结并判断良恶性,具有较好发展前景。     

超声造影预测乳腺癌腋窝淋巴结转移的多因素分析

目的分析腋窝淋巴结和乳腺癌原发灶的常规超声及CEUS表现,探讨其与腋窝淋巴结转移的相关性。方法回顾性分析41例乳腺癌患者的腋窝淋巴结及其乳腺原发灶的常规超声及CEUS资料,观察腋窝淋巴结及乳腺原发灶的大小、形态、纵横比、淋巴结皮质厚度、血流分级、造影灌注顺序、增强模式、径线扩大、周边放射状血管增强及造影各参数等。经单因素和Logistic多因素回归分析,检验上述指标与腋窝淋巴结转移的相关性。结果单因素分析显示淋巴结纵横比、淋巴结最大皮质厚度、淋巴结血流分级、淋巴结周边声晕、淋巴结灌注顺序、淋巴结增强方式、淋巴结径线扩大、淋巴结边缘增强及乳腺癌原发灶相对曲线下面积差等与淋巴结转移相关,差异有统计学意义(P<0.05);多因素分析结果显示淋巴结增强方式、造影后淋巴结径线扩大与淋巴结转移相关,差异有统计学意义(P<0.05)。结论通过腋窝淋巴结的CEUS指标可准确预测淋巴结的转移情况,对临床有重要指导作用。     

乳腺癌动态增强MRI表现与腋窝淋巴结转移的关系

目的 探讨乳腺癌动态增强MRI表现与腋窝淋巴结转移的关系。方法 对79例乳腺癌患者（腋窝淋巴结转移31例、无腋窝淋巴结转移48例）的临床及动态增强MRI资料进行回顾性分析,参照乳腺影像报告和数据系统（BI-RADS）标准系统描述病变MRI表现,分析MRI表现与腋窝淋巴结转移的关系。结果 MRI显示肿块样病变71例（71/79,89.87%）,病理诊断腋窝淋巴结转移27例。腋窝淋巴结转移与未转移乳腺癌病变位置差异有统计学意义（P<0.05）,病变类型差异无统计学意义（P>0.05）。腋窝淋巴结转移与未转移乳腺肿块样病变边缘特征、早期强化模式及肿块最大径差异均有统计学意义（P均<0.05）,病变形态、内部强化方式、延迟期时间-信号强度曲线类型差异均无统计学意义（P均>0.05）。结论 动态增强MRI显示的乳腺癌病灶位置及肿块大小、边缘特征、早期强化模式均与腋窝淋巴结转移有关。     

Five Cases of Axillary Lymph Node Metastatic Breast Cancer on Contrast‐Enhanced Sonography

This study was performed to determine the importance of contrast‐enhanced sonography for axillary lymph node metastatic breast cancer. Contrast‐enhanced sonographic findings in 5 patients with breast cancer and axillary lymph node metastasis are discussed, and imaging‐pathologic correlations are also presented in 3 cases. In all 5 cases, lymph nodes showed a perfusion defect in the late phase. Rapid arterial enhancement and wash‐out were observed in 2 cases in which we performed second injections. Contrast‐enhanced sonography may be effective for identifying metastatic lesions in lymph nodes, especially in the early stages.     

Application of neoadjuvant chemotherapy combined with anlotinib in occult breast cancer: A case report and review of literature

BACKGROUNDOccult breast cancer (OBC) is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast. Due to its low incidence and unique clinical manifestations, there is a lack of consensus on the diagnosis and treatment of OBC. We report a case of OBC treated with neoadjuvant chemotherapy combined with anlotinib. The treatment was well tolerated, and the patient achieved a pathologic complete response.CASE SUMMARYA 53-year-old woman presented with a lump in her right axillary area with no primary lesions in the breast. Pathological biopsy confirmed right axillary metastatic carcinoma. Immunohistochemical staining results were positive for progesterone receptor, cytokeratin 7, specific breast markers GATA3 and gross cystic disease fluid protein-15. Tumor cells were negative for estrogen receptor, human epidermal growth factor receptor-2, cytokeratin 5/6, cytokeratin 20, and villin. The patient was diagnosed with OBC, and she underwent neoadjuvant chemotherapy combined with anlotinib. Mastectomy plus axillary lymph node dissection was performed. The patient achieved pathologic complete response with no residual invasive tumor cells in the breast or axillary lymph nodes. Postoperatively, she received adjuvant radiotherapy and endocrine therapy.CONCLUSIONNeoadjuvant chemotherapy and anlotinib had good efficacy and safety in the treatment of OBC and may be a new therapeutic option.     

乳腺X线图像纹理特征预测乳腺癌腋窝淋巴结转移

目的 探讨乳腺X线图像纹理特征预测乳腺癌腋窝淋巴结转移的价值。方法 回顾性分析171例病理证实为非特殊类型浸润性乳腺癌患者的X线及临床资料。所有患者均接受腋窝淋巴结清扫手术,并根据手术及病理结果将患者分为腋窝淋巴结转移组和非转移组。分析患者的X线头尾位图像纹理特征,应用灰度直方图及灰度共生矩阵纹理分析方法测定均值、标准偏差、偏度、峰度、方差、能量、熵、自相关、惯量、逆差距和反差等11个纹理参数。结果 171例患者中淋巴结转移组96例,非转移组75例。X线检出腋窝淋巴结阴性119例,阳性52例,其诊断腋窝淋巴结转移的敏感度和特异度分别为48.96%（47/96）和93.33%（70/75）。X线图像纹理分析结果显示腋窝淋巴结转移组能量、熵、逆差距、自相关值均高于非转移组,惯量、反差值均低于非转移组（P均< 0.05）;其余纹理特征参数值两组间差异无统计学意义（P均> 0.05）。纹理参数值能量、熵、惯量、逆差距、自相关和反差诊断腋窝淋巴结转移的ROC曲线下面积（AUC）值分别为0.610、0.610、0.374、0.599、0.612和0.421（P均< 0.05）。乳腺X线检查、纹理特征及X线联合纹理特征诊断腋窝淋巴结转移的AUC值分别为0.711、0.676和0.787（P均< 0.05）;纹理特征、乳腺X线联合纹理特征诊断腋窝淋巴结转移的敏感度分别为62.5%和64.6%,特异度分别为66.7%和82.7%。结论 乳腺X线图像纹理参数对腋窝淋巴结转移有一定的预测作用,且乳腺X线联合纹理特征可提高对腋窝淋巴结转移的诊断效能。     

探讨超声弹性成像参数与乳腺癌腋窝淋巴结转移及Ki-67表达的相关性

目的 探讨乳腺癌病灶超声弹性成像(UE)中的硬度评分、UE图和二维超声(2D-US)图两种成像模式中的面积比与腋窝淋巴结转移及Ki-67表达有无相关性.方法 收集经病理组织学证实的乳腺癌患者60例,共60个病灶.对所有患者手术前均行常规超声及UE检查,判断病灶硬度评分,分别测量病灶在UE图与2D-US中的面积,系统软件自动计算面积比值.术后采用免疫组织化学方法测定Ki-67的表达.分析乳腺癌病灶的UE硬度评分、UE图和2D-US图两种成像模式中的面积比与腋窝淋巴结转移及Ki-67表达的相关性.结果 乳腺癌病灶UE硬度评分与腋窝淋巴结转移和Ki-67表达均无相关性(P均＞0.05).乳腺癌病灶在UE与2D-US两种不同成像模式中测量的面积比与腋窝淋巴结转移无相关性(P＞0.05),与Ki-67表达呈正相关(r=0.368,P=0.004).结论 UE硬度评分不能作为乳腺癌预后判断的指标.UE与2D-US两种不同成像模式测量的乳腺癌病灶面积比不能预示乳腺癌患者腋窝淋巴结的转移情况,但有助于了解乳腺癌患者癌细胞增殖情况和判断患者预后.