王静 李毅

    [摘要] 目的 探讨超声影像在乳腺癌腋窝淋巴结转移诊断中的临床应用价值。 方法 回顾性分析2008年1月～2017年7月在北京儿童医院顺义妇儿医院乳腺中心接受诊疗的682例新发浸润性乳腺癌患者的临床资料，通过超声影像中腋窝淋巴结的形态及皮质厚度，将患者分为腋窝淋巴结无异常组419例和异常组263例。异常组患者接受细针针吸细胞学检查，发现癌细胞者进入治疗；未发现明显癌细胞者与无异常组患者均接受前哨淋巴结活检。超声诊断淋巴结异常的263例中有215例经病理诊断證实为阳性，超声诊断淋巴结无异常的419例中有99例经病理诊断证实为阳性。以组织病理学诊断结果为金标准，分析腋窝淋巴结超声分类标准的诊断价值，采用Kappa检验评价超声和病理对腋窝淋巴结状态诊断的一致性，采用Pearson χ2检验探索腋窝淋巴结转移相关因素。 结果 超声影像评价腋窝淋巴结转移的灵敏度、特异度、阳性预测值及阴性预测值依次为68.5%、87.0%、81.7%、76.4%；超声和病理对腋窝淋巴结状态诊断的一致性较好，Kappa值为0.561。腋窝淋巴结转移与家族史具有相关性(P 0.05)。 结论 超声影像在乳腺癌腋窝淋巴结转移诊断中具有较高的临床应用价值。腋窝淋巴结转移与患者家族史有相关性，与年龄、月经状态、分子分型无明显相关性。

    [关键词] 乳腺癌；腋窝淋巴结转移；超声影像；诊断价值

    [中图分类号] R737.9 [文献标识码] A [文章编号] 1673-7210(2018)09(c)-0070-04

    [Abstract] Objective To evaluate the clinical value of ultrasonography in the diagnosis of axillary lymph node metastasis in breast cancer. Methods Clinical data of 682 primary invasive breast cancer patients who underwent treatment in Breast Center， Shunyi Women′s and Children′s Hospital of Beijing Children′s Hospital from January 2008 to July 2017 were studied retrospectively. Patients were divided into normal group (n = 419) and abnormal group (n = 263) depending on the morphology and cortical thickness of axillary lymph nodes through ultrasonography. The patients in the abnormal group underwent ultrasound guided fine needle aspiration (FNA). Except for patients who were diagnosed with positive axillary lymph nodes ......