超声及钼靶对乳腺癌新辅助化疗后腋窝淋巴结状态的诊断价值评估

目的:评估乳腺癌新辅助化疗(neoadjuvant chemotherapy，NAC)后腋窝淋巴结的变化，探讨超声及钼靶在NAC疗效评价中的应用价值。方法:对我院176例经穿刺病理证实为腋窝淋巴结转移的乳腺癌患者行NAC，所有患者NAC前后均行彩超与钼靶检查，对比两种检查的灵敏度、特异度及准确率。评价NAC后腋窝淋巴结的状态，并评估临床缓解与病理完全缓解（pathological complete response，pCR）的相关性。结果:NAC后超声、钼靶及两者联合评估的灵敏度分别为:79.4%、76.6%、86.5%；特异度分别为:68.6%、51.4%、71.4%；准确率分别为:77.3%、71.6%、83.5%；较NAC前超声、钼靶及两者联合评估的灵敏度、特异度及准确率明显下降，阳性预测价值最高的为两者联合检查（92.4%）。NAC后超声图像评估44例达到临床完全缓解，其中25（25/44，56.8%）例患者经病理证实达到pCR，NAC后超声检查评估pCR的灵敏度为71.4%，特异度为86.5%，准确率为83.5%。结论:超声诊断NAC后腋窝淋巴结转移较钼靶诊断灵敏度、特异度及准确率高，具有重要的临床诊断价值，但尚存局限性，对手术及术后治疗的指导性仍需进一步研究。

The diagnostic value of ultrasonography and mammography in the prediction of lymph node status after neoadjuvant chemotherapy for breast cancer

Objective:To investigate the application value of ultrasound and mammography for the assessment of lymph node status after neoadjuvant chemotherapy(NAC)for breast cancer.Methods:Our study was performed on 176 cases underwent neoadjuvant chemotherapy who were confirmed by biopsy for breast cancer with axillary lymph node metastasis.The sensitivity,specificity,and accuracy of ultrasonography,mammography,and their combinations were evaluated before and after neoadjuvant chemotherapy.Ultrasound evaluated the state of axillary lymph nodes after NAC,and correlation between clinical complete response and pathological complete response(pCR)of cases was compared.Results:The sensitivity of ultrasonography,mammography,and their combination in post-NAC axillary imaging was 79.4%,76.6%and 86.5%,respectively.The specificity was 68.6%,51.4%,and 71.4%,respectively.The accuracy was 77.3%%,71.6%,and 83.5%,respectively.They were lower than pre-NAC.The positive predictive value was highest for ultrasonography and mammography combination(92.4%).44 patients were achieved clinical complete remission by ultrasound image assessment after NAC,and 25 patients(25/44,56.8%)confirmed to pCR.The pCR detection rate by ultrasound examination after NAC showed sensitivity of 71.4%,specificity of 86.5%,accuracy of 83.5%.Conclusion:The ultrasonic diagnosis of subaxillary lymph node metastasis after NAC is more sensitive,specific and accurate than that of molybdenum target,but it has limitations.Whether this information might be used to tailor surgical and post-surgical treatment requires further investigation.