钼靶、CT与DCE-MRI评价乳腺癌淋巴结转移的价值

目的分析钼靶（MG）、计算机断层扫描（CT）与动态增强磁共振成像（DCE-MRI）对乳腺癌患者腋窝淋巴结有无转移的诊断价值。方法回顾性分析2014年2月~2015年10月在我院就诊的乳腺癌的女性患者109例，以淋巴结病理检查结果为金标准，比较和分析MG、CT及DCE-MRI诊断乳腺癌腋窝淋巴结转移(LNM)的灵敏度、特异度、准确度、阳性预测值以及阴性预测值。结果纳入的乳腺癌患者中，39.4%（43/109）的患者病理确诊LNM。MG诊断LNM的灵敏度、特异度、准确度、阳性预测值以及阴性预测值分别为：14.0%、84.8%、56.9%、37.5% 和60.0%。CT诊断腋窝LNM的灵敏度、特异度、准确度、阳性预测值以及阴性预测值分别为：93.0%、57.6%、71.6%、58.8%和92.7%。DCE-MRI诊断腋窝LNM的灵敏度、特异度、准确度、阳性预测值以及阴性预测值分别为：95.3%、65.2%、77.1%、64.1% 和95.6%。与病理结果相比较，MG、CT、DCE-MRI 的κ值分别为-0.13、0.459、0.558。MG的特异度高于CT和DCE-MRI，但灵敏度、准确度、阳性预测值、阴性预测值均明显低于CT及DCE-MRI，差异具有统计学意义。DCE-MRI与CT相比，前者的灵敏度、特异度、准确度、阳性预测值、阴性预测值均高于后者，差异具有统计学意义（P<0.05）。结论对于乳腺癌腋窝LN 有无转移，DCE-MRI 的诊断效能明显优于CT 和MG，而CT 明显优于MG。DCE-MRI和CT均可以提供相对较准确的LNM相关情况，在这方面的临床应用价值较高。MG常不能为临床提供可靠的信息，利用MG判断LNM时必须谨慎，并结合其他检查。

Value of mamography,CT and DCE-MRI in detecting axillary lymph node metastasis of breast cancer

Objective To evaluate the diagnostic value of mammography, computed tomography (CT), and dynamiccontrast-enhanced magnetic resonance imaging (DCE-MRI) for axillary lymph node staging in breast cancer patients. MethodsFrom February, 2014 to October, 2015, 109 women with breast cancer received examinations with preoperative mamography,CT, and DCE-MRI. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value ofthe 3 modalities were evaluated using histopathologic assessments as the gold standard. Results In total, 39.4% (43/109) of thepatients had axillary lymph node metastasis. The sensitivity, specificity, accuracy, positive predictive value, and negativepredictive value of mamography for determining lymph node metastasis were 14.0% , 84.8% , 56.9% , 37.5% and 60.0% ,respectively; those of CT were 93.0%, 57.6%, 71.6%,58.8% and 92.7%, and those of DCE-MRI were 95.3%, 65.2%, 77.1%, 64.1%and 95.6%, respectively. Compared with the histopathologic result, the Kappa coefficients of mamography, CT, and DCE-MRIwere -0.13, 0.459 and 0.558, respectively. The specificity of mamography was significantly higher (P<0.05), but its sensitivity,accuracy, positive predictive value, and negative predictive value were significantly lower than those of CT and DCE-MRI (P<0.05). Compared with CT, DCE-MRI had significantly higher sensitivity, specificity, accuracy, positive predictive value, andnegative predictive value for diagnosis of lymph node metastasis (P<0.05). Conclusion DCE-MRI has a greater diagnosticpower than CT and mammography, and CT has a greater diagnostic power than mammography for axillary lymph nodemetastasis in breast cancer patients. Mamography alone should be used cautiously for the diagnosis of lymph node metastasis.