彩色多普勒超声对乳腺癌腋窝淋巴结转移的预测价值

目的 探讨彩色多普勒超声对乳腺癌腋窝淋巴结转移的预测价值.方法 收集首都医科大学宣武医院2011年1月至2014年12月236例女性乳腺癌手术患者的临床资料,对患者腋窝淋巴结转移情况进行回顾性分析.记录肿块大小、纵横比、边缘特征（毛刺征）、彩色多普勒血流分级、类型、最高流速、阻力系数及腋窝淋巴结状况,应用χ2检验及Logistic回归分析进行统计分析.结果 在236例女性乳腺癌手术患者中腋窝淋巴结转移115例、未转移121例.Logistic回归分析显示：肿瘤原发灶最大径＞3cm[比值比（OR）=10.767,P=0.000]、乳晕区及多发病灶（OR=4.092,P=0.004）是腋窝淋巴结转移的独立危险因素.在超声变量中原发灶毛刺征（OR=2.122,P=0.006）、Ⅲ级血流（OR=4.030,P=0.007）、穿入血流类型（OR=3.051,D=0.008）和腋窝淋巴结数目（OR=2.687,P=0.001）与腋窝淋巴结转移相关.结论 乳腺癌腋窝淋巴结转移,与肿瘤大小、数目、位置高度相关.超声检查乳腺癌原发灶位置、毛刺征、血流分级、血流类型及腋窝淋巴结数目与腋窝淋巴结转移相关.

Ultrasonography evaluation of axillary lymph nodes in patients with breast cancer

Objective To investigate the predictive value of color doppler ultrasound for node metastases of breast cancer axillary lymph.Methods The collection of Xuanwu Hospital of Capital Medical University in 2011 January to 2014 December,236 female patients with breast cancer who underwent surgical treatment; clinical data of patients with axillary lymph node metastasis was analyzed retrospectively.Ultrasonic detection included tumour size,ratio of length and breadth,edge features（spiculations）,classification and type of color doppler flow imaging; peak systolic velocity; resistance index and status of axillary lymph node were recorded.Results All 236 cases were female patients.The results of operation showed that 115 cases had axillary lymph node metastasis and 121 cases had no metastasis.The analysis of axillary lymph nodes metastases showed：tumor size 〉 3 cm（OR =10.767,P =0.000）,tumor location （mammary areolar region） and multiple tumor foci （OR =4.092,P =0.004） were risk factors of axillary lymph nodes metastases.Spicule sign（OR =2.120,P =0.006）,grade of blood flow （OR =4.030,P =0.007）,type of blood vessel（OR =3.051,P =0.008） and the numbers of axillary lymph node （OR =2.687,P =0.001） were the factors for evaluating the correlated with axillary lymph node metastases.Conclusions Breast cancer with axillary lymph node metastasis is associated with multiple factors,such as tumor size,location and numbers.For judgment of axillary lymph node metastase in patients with primary breast cancer,the position of tumour,type of blood and number of axillary lymph node detected by ultrasound are associated with axillary lymph node metastasis.