| 摘要: |
| 目的 探索超声和超声引导下淋巴结细针穿刺（FNA）细胞学检查在三阴性乳腺癌淋巴结转移术前评估中的应用价值。方法 选择我院证实为三阴性乳腺癌的女性患者作为研究对象。对检出的淋巴结进行多切面探查，观察其形态、大小、长径/短径、皮质回声、淋巴门结构、淋巴结皮质厚度以及血供情况。对超声或临床可疑的腋窝淋巴结进行超声引导下FNA细胞学检查，评价超声腋窝淋巴结检查以及超声引导下腋窝淋巴结FNA细胞学检查的诊断效能。利用Logistic回归建立多指标联合诊断三阴性乳腺癌腋窝淋巴结转移的数学模型，并建立ROC曲线分析该模型鉴别转移性淋巴结的价值。结果 病理结果显示转移组35例，反应组31例。L/S≤2、边缘形态不规则和淋巴门缺失对淋巴结转移存在显著影响（均P＜0.05）。超声检查对三阴性乳腺癌转移性腋窝淋巴结的诊断灵敏度、特异度分别68.57%、64.52%。超声引导下FNA对三阴性乳腺癌转移性腋窝淋巴结的诊断灵敏度、特异度分别为85.71%、83.87%。联合诊断拟合方程为logit(P) =-5.301+2.860*穿刺结果+3.259*淋巴门+2.326*边缘形态+2.081*L/S。其AUC为0.959，最佳诊断点为0.510，敏感性88.57%，特异性96.77%。结论 腋窝淋巴结FNA联合超声指标诊断转移性淋巴结的准确性优于FNA单独诊断。 |
| 关键词: 超声，细针穿刺，淋巴结，三阴性乳腺癌 |
| DOI： |
| 投稿时间：2018-11-23修订日期：2019-01-01 |
| 基金项目: |
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| Value of ultrasound combined with biopsy based on logistic regression for evaluation of lymph node metastasis in triple-negative breast cancer |
| ZHENG Xiao-Jue,LI Mei |
| () |
| Abstract: |
| Objective To explore the value of ultrasound and ultrasound-guided lymph node fine needle aspiration (FNA) cytology in preoperative evaluation of triple-negative breast cancer lymph node metastasis. Methods Female patients confirmed to be triple-negative breast cancer in our hospital were recruited as subjects. Multi-faceted examination of the detected lymph nodes was performed to observe the morphology, size, long diameter/short diameter, cortical echo, lymphatic portal structure, lymph node cortical thickness and blood supply. Ultrasound-guided FNA cytology was performed on ultrasound or clinically suspected axillary lymph nodes to evaluate the diagnostic efficacy of ultrasound examination and ultrasound-guided FNA cytology of axillary lymph nodes. Logistic regression was used to establish a mathematical model for multi-index combined diagnosis of axillary lymph node metastasis in triple-negative breast cancer, and the diagnostic value of the model was analyzed by ROC curve. Results Pathological results showed that 35 cases in the metastatic group and 31 cases in the reaction group. L/S ≤ 2, marginal morphology irregularities and missing lymphatic portal had significant effects on lymph node metastasis (all P<0.05). The diagnostic sensitivity and specificity of ultrasonography for metastatic axillary lymph nodes in triple-negative breast cancer were 68.57% and 64.52%, respectively. The sensitivity and specificity of ultrasound-guided FNA for metastatic axillary lymph nodes in triple-negative breast cancer were 85.71% and 83.87%, respectively. The combined fitting equation was logit(P) = -5.301 + 2.860* aspiration result + 3.259 * lymphatic portal + 2.326 * marginal morphology + 2.081 * L / S. Its AUC was 0.959, and the best diagnostic point was 0.510. The sensitivity was 88.57%, and the specificity was 96.77%. Conclusion The accuracy of FNA combined with ultrasound in the diagnosis of metastatic lymph nodes is better than FNA alone. |
| Key words: ultrasound fine needle aspiration lymph node triple negative breast cancer |
