多参数超声联合穿刺诊断三阴性乳腺癌腋窝淋巴结转移

目的:探索常规超声、剪切波弹性成像(SWE)和超声引导下细针穿刺(FNA)联合应用在三阴性乳腺癌(TNBC)腋窝淋巴结转移术前评估中的价值。方法:选择贵州医科大学附属医院经病理证实的TNBC患者作为研究对象。其中转移组48例,反应组57例。对检出的淋巴结进行常规超声及SWE检查,比较转移组与反应组超声及SWE多参数指标。对可疑的腋窝淋巴结进行超声引导下FNA细胞学检查,评价常规超声、SWE、FNA及三者联合对TNBC腋窝淋巴结的诊断效能。结果:转移组淋巴结长径(L)/短径(S)比值(L/S)≤2、形态不规则、淋巴门缺失以及未见淋巴门型血流分布的患者比例多于反应组,杨氏模量(YM)平均值高于反应组,差异均具有统计学意义(均P<0.05)。SWE对TNBC转移性腋窝淋巴结的诊断敏感性(87.50%)高于常规超声(79.17%)及FNA(75.00%);而FNA诊断TNBC转移性腋窝淋巴结的特异性(94.74%)高于SWE(82.46%)和常规超声(70.18%)。三者联合诊断拟合方程为Logit(P)=-5.301+5.860×FNA阳性+2.259×L/S≤2+1.326×形态不规则+4.081×淋巴门缺失+2.729×未见淋巴门型血流+0.121×YM平均值。三者联合的敏感性为97.92%,高于常规超声、SWE及FNA,特异性为87.72%,稍低于FNA,但明显高于常规超声及SWE。结论:常规超声、SWE与腋窝淋巴结FNA联合提高了诊断TNBC腋窝淋巴结转移的准确性。

Diagnosis of axillary lymph node metastasis in triple-negative breast cancer by multi-parameter ultrasound combined with biopsy

Objective: To explore the value of conventional ultrasound combined with shear wave elastography(SWE) and ultrasound-guided fine needle aspiration(FNA) cytology in preoperative evaluation of axillary lymph node metastasis in triplenegative breast cancer(TNBC). Methods: Female patients pathologically confirmed to be TNBC in the Guizhou Medical University Affiliated Hospital were recruited as subjects. There were 48 cases in the metastatic group and 57 cases in the reaction group. The detected lymph nodes were subjected to conventional ultrasound and SWE examination, and the ultrasound and SWE multi-parameter indicators of the metastatic group and the reaction group were compared. Ultrasound-guided FNA cytology was performed on suspected axillary lymph nodes to evaluate the diagnostic efficacy of conventional ultrasound, SWE,FNA, and the combination of the three in TNBC axillary lymph nodes. Results: The proportion of patients with metastatic lymph nodes in long to short dimension ratio(L/S)≤2, irregular morphology, missing lymphatic portal, and no lymphatic portal blood flow distribution was higher than that of the reaction group. The mean young’s module(YM) was higher than that of the reaction group, and the difference was statistically significant(both P<0.05). The sensitivity of SWE(87.50%) for the diagnosis of TNBC metastatic axillary lymph nodes was higher than that of conventional ultrasound(79.17%) and FNA(75.00%). The specificity of FNA(94.74%) for the diagnosis of TNBC metastatic axillary lymph nodes was higher than that of SWE(82.46%) and conventional ultrasound(70.18%). The combined fitting equation of conventional ultrasound, SWE and FNA was Logit(P)=-5.301+5.860 ×positive FNA +2.259 ×L/S ≤2 +1.326 ×irregular morphology +4.081 ×missing lymphatic portal +2.729 ×no lymphatic portal blood flow+0.121×YM average. The sensitivity of the combination was 97.92%, which was higher than that of conventional ultrasound, SWE and FNA respectively. The specificity was 87.72%, which was slightly lower than FNA, but significantly higher than conventional ultrasound and SWE. Conclusion: Conventional ultrasound combined with elastography and ultrasound-guided FNA could improve the accuracy in diagnosis of metastatic axillary lymph node of TNBC.