高频超声对乳腺肿块患者腋窝淋巴结良恶性鉴别的诊断价值

目的探讨高频超声对乳腺肿块术前诊断腋窝淋巴结良恶性的临床价值。方法采用高频超声对85例乳腺肿块患者腋窝146个肿大的淋巴结术前进行形态、大小、数目及血流动力学指标的观察。结果术后病理证实恶性淋巴结为124个,淋巴结长径0.8～3.5cm,长短径之比<2,内部为不均匀的低回声,淋巴结皮质不均匀增厚或消失,淋巴结门偏心或消失。血流分布主要为周边型和混合型,并随淋巴结的增大血流信号增多,平均RI>0.73。良性淋巴结22个,长径0.5～1.2cm,长短径之比>2,边界清晰,淋巴门回声存在。血流分布主要为淋巴门处见放射状血流分布,平均RI<0.65。结论恶性淋巴结的超声图像在形态、边缘、内部回声、血流分布、血流动力学等方面与良性淋巴结相比有较为特征性的表现,二维超声与彩色多普勒结合,可提高检出恶性淋巴结的准确性。

Value of high-frequency ultrasonography in differentiating benign from malignant axillary lymph nodes in patients with breast masses

Purpose To discuss the clinical value of high-frequency ultrasonography in differentiating benign or malignant axillary lymph nodes in patients with breast masses. Methods The shape, size, number and its hemodynamics of 146 axillary lymph nodes in 85 patients with breast masses were observed preoperatively. Results In 124 malignant lymph nodes which were confirmed by pathology, the diameter ranged from 0.8 to 3.5cm with a ratio (long/short) of less than 2. The lymph nodes presented heterogeneous hypoechogenicity, thickened cortical layer, and decentered or disappearance of hilum on gray scale ultrasonography. Color flow signals were mainly appeared as peripheral or mixed type, and increased with the size of lymph nodes. The mean value of RI>0.73. In 22 benign lymph nodes,the diameter ranged from 0.5 to 1.2cm with a ratio (long/short) higher than 2. The lymph nodes showed clear margin with the presence of hilum. Color flow signals presented radiative at the hilum of lymph nodes and the mean value of RI<0.65. Conclusion The shape, margin, echogenicity and hemodynamics are different between benign and malignant axillary lymph nodes on ultrasonography. The combination of gray scale and color Doppler flow imaging can improve the diagnostic accuracy of malignant lymph nodes.