超声引导下空芯针和针吸活检对乳腺癌内乳淋巴结诊断价值的比较

  目的  评估超声引导下空芯针活检(core needle biopsy，CNB)和针吸活检(fine needle aspiration，FNA)对乳腺癌内乳淋巴结（internal mammary node，IMN）转移的诊断价值。  方法  回顾性分析2012年5月至2020年10月河北医科大学第四医院496例行超声引导下IMN穿刺的乳腺癌患者临床资料，其中CNB组374例、FNA组122例，采用一致性Kappa检验分析CNB、FNA的诊断效能，计算诊断的敏感度、特异度等指标。亚组分析不同大小及类型IMN的CNB、FNA诊断效能及影响标本满意度的因素。  结果  CNB组和FNA组穿刺标本不满意度分别为5.6%（21/374）和3.3%（4/122），差异无统计学意义（P>0.05）。剔除不满意标本后比较CNB、FNA的诊断效能，其Kappa值分别为0.817、0.907。亚组分析显示IMN厚径<0.5 cm组和0.5~0.9 cm组中，CNB、FNA的Kappa值分别为0.877、1.000和0.772、0.783（均P<0.01）；IMN厚径≥1.0 cm组中，CNB组的假阴性率为3.4%（1/29），FNA组无假阴性。  结论  对于IMN定性诊断，FNA诊断效能更高，由于IMN一般较小且位置特殊，FNA也是更安全的穿刺方法。 

Comparison of the diagnostic value of ultrasound-guided core needle biopsy and fine needle aspiration in internal mammary nodes of patients with breast cancer

  Objective  To evaluate the diagnostic value of ultrasound-guided core needle biopsy (CNB) and fine needle aspiration (FNA) in the metastatic internal mammary node (IMN) of breast cancers (BCs).  Methods  The data of 496 BCs patients who underwent ultrasound-guided IMN biopsy from May 2012 to October 2020 in The Fourth Hospital of Hebei Medical University were retrospectively analyzed. There were 374 cases in CNB group, and 122 cases in FNA group. Consistency kappa test was used to analyze the diagnostic efficacy of CNB and FNA, and the sensitivity and specificity were calculated. The diagnostic efficacy of CNB and FNA in different sizes and types of IMN and the factors influencing specimen satisfaction were analyzed.  Results  The rates of unsatisfied specimens in CNB and FNA were 5.6% (21/374) and 3.3% (4/122), respectively (P>0.05). Excluding the unsatisfied specimens, the Kappa values of CNB and FNA were 0.817 and 0.907. Subgroup analysis showed that Kappa values of CNB and FNA were 0.877, 1.000 and 0.772, 0.783 in IMN with thickness <0.5 cm and 0.5-0.9 cm groups, respectively (P<0.01). In IMN with thickness ≥1.0 cm group, the false negative rate of CNB was 3.4% (1/29), and there was no false negative in the FNA group.  Conclusions  For the qualitative diagnosis of IMN, FNA had a higher diagnostic efficiency. FNA is also a safer biopsy method because IMN is generally small, with a special location.