超声联合空芯针穿刺活检在原发性乳腺癌腋窝淋巴结转移中的诊断价值

目的研究术前超声引导下淋巴结空芯针穿刺(US-CNB)在检测乳腺癌患者腋窝淋巴结转移中的诊断价值。方法回顾性研究2016年1月至2017年7月在我院行超声检查及超声引导下空芯针穿刺活检,并有腋窝淋巴结术后病理诊断的所有乳腺癌病人。计算US-CNB的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、准确性,同时统计Kappa值以明确一致性情况。分析US-CNB结果与N和T分期的关系。结果以术后病理结果为金标准,US-CNB诊断淋巴结转移的敏感性为91.8%(90/98),特异性为58.3%(21/36),PPV为85.7%(90/105),NPV为72.4%(21/29),误诊率为41.7%(15/36),漏诊率为8.2%(8/98),约登指数为50.1%,准确性82.8%(111/134),ROC曲线下面积为0.751。比较US-CNB与术后病理的一致性,Kappa=0.535。排除新辅助化疗患者14例,特异性、PPV和误诊率分别为95.5%(21/22)、98.9%(90/91)以及4.5%,约登指数87.3%,准确性92.5%(111/120),ROC曲线下面积为0.936(P0.0001),比较排除后US-CNB与术后病理的一致性,Kappa=0.777。随着T和N分期的增加,US-CNB的敏感性增加。结论乳腺癌患者术前腋窝淋巴结空芯针穿刺可作为诊断腋窝淋巴结转移的可靠方法,与术后病理有较高的一致性。淋巴结穿刺结果阳性可能与乳腺癌较高肿瘤负荷相关。

The diagnosis value of ultrasonography guided core needle biopsy for axillary lymph nodes of primary breast cancer

［Abstract］ Objective To evaluate the diagnosis value of ultrasonography guided core needle biopsy （US?CNB）for detecting axillary lymph node metastasis of primary breast cancer. Methods We retrospectively reviewed 134 breast cancer patients who underwent US, US?CNB and axillary lymph node surgery in our department from Jan. 2016 to Jul. 2017. The diagnostic performance of US?CNB for detecting axillary lymph node metastasis was calculated on the basis of final pathologic reports of axillary lymph node surgery. Analysis the correlation of US?CNB results with stage N and stage T. Results The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）and accuracy of US?CNB were 91.8%（90/98）, 58.3%（21/26）, 85.7%（90/105）, 72.4%（21/29）and 82.8%（111/134）, respectively, Youden′s index was 50.1%, AUC was 0.751, Kappa=0.535. Excluding 14 patients who underwent adjuvant chemotherapy, the specificity, PPVand accuracy of US?CNB in the remaining 120 patients were95.5%（21/22）, 98.9%（90/91） and 92.5%（111/120）, respectively, Youden′ s index was 87.3%, AUC was 0.936, Kappa=0.777. The sensitivity of US?CNB in stage N1?N3 were 86.8%（46/53）, 96.2%（25/26）and 100%（19/19）, respectively. The sensitivity of US?CNB in stage T1?T4 were 84.2% （16/19）, 91.1%（51/56）, 100%（18/18）and 100%（5/5）, respectively. Conclusion US?CNB is useful in the preoperative diagnosis for axillary lymph node metastasis of primary breast cancer. Patients with US?CNB detected axillary lymph node metastases may had a higher tumor burden.