MRI评价乳腺癌腋窝淋巴结转移的价值

目的：探讨 MRI评估乳腺癌腋窝淋巴结转移的应用价值。方法对60例乳腺癌患者进行术前 MRI检查,评价乳腺内肿瘤最大径、瘤体最大信号增强率(SERmax )及同侧腋窝淋巴结的大小、形态、边缘、信号强度和强化方式,并与术后同侧腋窝淋巴结状态进行对照分析。结果60例乳腺癌患者 MRI显示28例同侧腋窝淋巴结有转移,病理证实22例腋窝淋巴结有转移。MRI 检出腋窝淋巴结转移的灵敏度、特异度、准确率为90.91%、78.95%、83.33%。57例同时行超声检查,超声检查诊断淋巴结转移的灵敏度、特异度、准确率分别为59.09%、94.29%、80.70%。腋窝淋巴结转移组淋巴结大小(1.20±0.59)cm,无转移组淋巴结大小(0.85±0.24)cm,2组间腋窝淋巴结大小差异有统计学意义(t=3.258,P=0.001<0.05)。腋窝淋巴结无转移与有转移组间乳腺内肿瘤 SERmax值差异有统计学意义(t=4.167,P=0.000<0.05),转移组 SERmax值大于无转移组。转移性淋巴结多表现为形态不规则,边缘不规整,信号强度及强化不均匀。结论乳腺 MRI能在检出乳腺癌的同时全面评价腋窝淋巴结,是术前评估腋窝淋巴结状态的有效检查方法。

The value of MRI in evaluation of metastatic axillary lymph nodes in breast carcinoma

Objective To investigate the value of MRI in evaluation of metastatic axillary lymph nodes in patients with breast carcinoma. Methods 60 patients with breast carcinoma underwent MRI before surgical management.Tumor maximal diameter,tumor SERmax (Maximal Signal Enhancement Ratio),the size,shape,border,signal intensity and enhancement pattern of ipsilateral axillary lymph nodes were recorded respectively.The results of MRI observation were compared with the histopathological results.Results Among the 60 patients,MRI showed that 28 cases had metastatic axillary lymph nodes,and 22 of them were confirmed by pathology.Its sensitivity,specificity and accuracy were 90.91%,78.95%,83.33% in the diagnosis of lymph nodes metastasis.Meanwhile,57 cases were underwent ultrasound examination,its sensitivity,specificity and accuracy were 59.09%,94.29%,80.70%.The sizes of lymph nodes in the patients with metastatic lymph nodes and the patients with no metastatic lymph nodes were(1.20±0.59)cm, (0.85±0.24)cm respectively.There was statistically significant difference between the two groups(t=3.258,P=0.001<0.05). There was statistically significant difference between the above two groups in the tumor maximum of SER(t=4.167,P=0.000<0.05),SERmax in metastatic lymph nodes were higher than in no metastatic ones.Irregular shape and border,inhomogeneous signal intensity and heterogeneous enhancement patterns were suggestive of metastatic lymph nodes.Conclusion MRI is an effective imaging modality in evaluation of axillary lymph nodes status in patients with breast carcinoma comprehensively before operation.