超声引导腋窝淋巴结穿刺活检术诊断乳腺癌淋巴结转移的应用分析

目的 探讨超声引导下腋窝淋巴结穿刺活检术对于乳腺癌淋巴结转移的诊断价值.方法 在本院2013年2月至2015年12月期间收治的乳腺癌患者中超声诊断为腋窝淋巴结异常者实施超声引导下穿刺活检(Ultrasound-guided core Needle Biopsy,UNB),在手术治疗后行病理检查,对乳腺癌淋巴结转移情况进行评估.结果 术前UNB对于腋窝淋巴结转移的诊断敏感率为62.5％(25/40),特异性为100.0％(60/60),阴性预测值为80.0％(60/75),阳性预测值为100.0％(25/25),准确率为85.0％(85/100);Kappa分析显示,术前UNB对腋窝淋巴结转移的诊断结果同术后病理之间存在较好的一致性(Kappa值=0.692);取材3针患者术前UNB诊断的敏感率、准确率及Kappa值均明显优于取材2针者,差异有统计学意义(P＜0.05).结论 超声影像学检查无法作为乳腺癌患者腋窝淋巴结转移状态评估的主要依据,在超声引导下实施穿刺活检可有效对早期淋巴结转移进行判断,效果显著,安全可靠,对于临床治疗方案的制定具有十分重要的意义.

Ultrasound guided axillary lymph node biopsy in the diagnosis of breast cancer lymphatic metastasis

Objeetive To discuss the clinical value of ultrasound guided axillary lymph node biopsy in the diagnosis of breast cancer lymphatic metastasis.Methods Breast cancer patients with axillary lymph node abnormalities diagnosed by ultrasound in our hospital from February 2013 to December 2015 received ultrasound guided axillary lymph node biopsy,underwent pathological examination after the surgical treatment.Assessed the situation of breast cancer lymphatic metastasis.Results The diagnostic sensitivity of preoperative UNB was 62.50％ (25/40),the specificity was 100.00％ (60/60),the negative predictive value was 80.00％ (60/75),the positive predictive value was 100.00％ (25/25),the accuracy rate was 85.00％ (85/100).Kappa analysis showed there was good consistency between preoperative UNB in the diagnosis of axillary lymph node metastasis and postoperative pathology (Kappa value =0.692).The diagnostic sensitivity,accuracy,and Kappa value of preoperative UNB in patients with 3 times of drawn needle were significantly better than those in patients with 2 times of drawn needle,with statistically significant differences (P＜0.05).Conclusions Ultrasound imageological examination can not be used as the main basis forstate assessment of breast cancer axillary lymph node metastasis;ultrasound guided axillary lymph node biopsy is effective in early lymph node metastasis judgment,with significant effect and high safety,has very important significance in the development of clinical treatment program.