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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 550 -553. doi: 10.3877/cma.j.issn.1674-3946.2021.05.023

论著

超声造影结合细针穿刺活检对乳腺癌前哨淋巴结的诊断效率
王晶1, 朱宇1, 胡永胜1, 李霞1, 贺菊1, 李旭1,(), 柳滿然2   
  1. 1. 402760 重庆市壁山区人民医院重庆市
    2. 400042 重庆医科大学第一附属医院
  • 收稿日期:2020-08-09 出版日期:2021-10-26
  • 通信作者: 李旭

Diagnostic value of ultrasonography guided with fine needle aspiration biopsy of sentinel lymph nodes of breast cancer

Jing Wang1, Yu Zhu1, Yongshen Hu1, Xia Li1, Ju He1, Xu Li1,(), Manran Liu2   

  1. 1. People’s Hospital of Bishan District, Chongqing 402760, China
    2. The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
  • Received:2020-08-09 Published:2021-10-26
  • Corresponding author: Xu Li
  • Supported by:
    Natural Science Foundation of China(31671481); General Project of Chongqing Health and Family Planning Commission(15PJ051)
引用本文:

王晶, 朱宇, 胡永胜, 李霞, 贺菊, 李旭, 柳滿然. 超声造影结合细针穿刺活检对乳腺癌前哨淋巴结的诊断效率[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(05): 550-553.

Jing Wang, Yu Zhu, Yongshen Hu, Xia Li, Ju He, Xu Li, Manran Liu. Diagnostic value of ultrasonography guided with fine needle aspiration biopsy of sentinel lymph nodes of breast cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(05): 550-553.

目的

探讨超声造影结合细针穿刺对乳腺癌前哨淋巴结( SLN)的诊断价值。

方法

回顾性分析2015年12月至2019年12月行手术切除术80例单发乳腺癌患者资料,对所有患者术前进行超声造影和细针穿刺活检,以术后病理诊断结果为金标准,采用SPSS 20.0对数据进行分析,灵敏度、特异度、准确度等计数资料采用配对χ2检验。绘制二者联合检测对SLN诊断的ROC曲线,并计算其曲线下面积(AUC)。以P<0.05为差异有统计学意义。

结果

经病理诊断,腋窝淋巴结阳性率为91.3%(73/80)。超声造影检查腋窝淋巴结转移67例,阴性13例。诊断准确度为87.5%(70/80),灵敏度为89.0%(65/73),特异度为71.4%(5/7)。细针穿刺活淋巴引流区常规操作手术域检结果显示,有63例患者诊断为阳性,阴性17例。诊断准确度为82.5%(66/80),灵敏度为83.6%(61/73),特异度为71.4%(5/7)。二者联合检淋巴引流区常规操作手术域测结果显示,有71例患者诊断淋巴引流区常规操作手术域为阳性,阴性9例。诊断准确度为92.5%(74/80),灵敏度为94.5%(69/73),特异度为71.4%(5/7)。二者联合检测的其AUC(0.891)明显大于单独超声造影的AUC(0.835)与单独细针穿刺活检的AUC(0.758)(P<0.05)。

结论

超声造影结合细针穿刺活检能够提高对乳腺癌SLN诊断的准确度和灵敏度,具有较高的诊断价值,值得在临床上推广应用。

Objective

To explore the diagnostic value of ultrasonography guided with fine needle aspiration biopsy of sentinel lymph nodes (SLN) of breast cancer.

Methods

The clinical data of 80 patients with single breast cancer underwent the surgical resection from December 2015 to December 2019 were analyzed retrospectively. All of 80 patients received preoperative contrast-enhanced ultrasound test as well as fine needle aspiration biopsy. The postoperative pathological diagnosis was considered as the gold standard. Statistical analysis were performed by using SPSS20.0 software. The degree of sensitivity, specific, and accuracy data were analyzed by using χ2 test. The ROC curve of ultrasonography guided with fine needle aspiration biopsy of SLN was plotted, and the area under the curve (AUC) was calculated. A P value of <0.05 was considered as statistically significant difference.

Results

The positive rate of pathological diagnosis of axillary lymph node was 91.3% (73/80). 67 patients had axillary lymph node metastasis under contrast-enhanced ultrasound. The diagnostic accuracy was 87.5% (70/80), sensitivity was 89.0% (65/73), and the specificity was 71.4% (5/7). Fine needle aspiration biopsy results showed that 63 cases of positive, while 17 cases of negative. The diagnostic accuracy was 82.5% (66/80), sensitivity was 83.6% (61/73), and the specificity was 71.4% (5/7). The guided test results of the two methods showed that 71 patients were diagnosed as positive and 9 patients were diagnosed as negative. The diagnostic accuracy was 92.5% (74/80), sensitivity was 94.5% (69/73), and the specificity was 71.4% (5/7). The ROC curve was drawn for the diagnosis of SLN in patients with breast cancer. The results showed that the AUC (0.891) of the guided detection was significantly greater than that of ultrasound contrast AUC (0.835) and fine needle aspiration biopsy (0.758 ) (P<0.05).

Conclusion

Ultrasonography guided fine-needle aspiration biopsy could improve the accuracy and sensitivity of the sentinel lymph node diagnosis of patients with breast cancer. It has high diagnostic value and is worthy of clinical application.

表1 80例单发乳腺癌患者临床病理特征
图1 乳腺癌患者SLN二维超声下穿刺活检与病理图 (A)二维超声表现肿块形态不规则,呈蟹足状,边界不清,低回声,高度怀疑为乳腺癌;(B)乳腺肿块粗针穿刺,病理活检确诊为乳腺癌浸润性导管癌(箭头所指"粗针");(C)乳腺肿块检测大小(红色直线描述肿块直径);(D)超声引导下腋窝淋巴结细针穿刺抽吸(箭头所指"细针");(E)乳腺癌前哨淋巴结病理组织图(HE×400);(F)乳腺癌前哨淋巴结细胞学检查阳性病理图(HE×400)
表2 80例乳腺癌患者超声造影与细针穿刺诊断结果[例(%)]
表3 80例乳腺癌患者超声造影与细针穿刺联合检测诊断结果[例(%)]
图2 80例乳腺癌患者不同检测方法的ROC曲线
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