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。

Axillary Lymph Node Metastasis in Breast Cancer Patients:Assessment of Related Predicting Ultrasonographic Factors

Objective To analyze the related ultrasonographic factors of axillary lymph node metastasis in breast cancer patients, and to acquire its predicting indices. Methods In 171 patients, ultrasonogrphic features of the primary tumor and the axillary lymph node were analyzed retrospectively. The primary tumor maximum size, abundance of blood supply, distribution and the number of axillary lymph nodes showed on ultrasonogrphy were observed. Univariate analysis by Chi squared test and Fisher exact test, and multivariate analysis to determine the independent significant individual variables by multiple Logistic regression analysis were performed. ROC curve analysis was done to determine the sensitivity and specificity of the features in predicting metastatic lymph nodes. Results The primary tumor maximum size and the number of axillary lymph nodes which were showed on ultrasonogrphy were found to be statistically significant factors on univariate analysis. The primary tumor maximum size, the number of axillary lymph nodes showed on ultrasonogrphy were proved to be significant independent predictors of axillary lymph node metastasis on Logistic regression analysis. Through ROC analysis, with the value of the primary tumor enlarged maximum size, the sensitivity was falling and the specificity was rising. Conclusions Ultrasonography is helpful in staging the primary tumor in breast cancer patients. The primary tumor size, the number of axillary lymph nodes showed on ultrasonogrphy are the main features to determine whether metastatic involvement is present or not.