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目的随着早期乳腺癌诊断率的不断提高,乳腺癌的腋窝淋巴结(axillary lymph node,ALN)转移率不断降低。本研究回顾性研究超声对乳腺癌ALN转移的诊断价值,并分析与乳腺癌前哨淋巴结(sentinel lymph node,SLN)转移相关的因素。方法收集2009-01-01-2013-01-01中国人民解放军第三〇七医院初治乳腺癌并行前哨淋巴结活检(sentinel lymph node biopsy,SLNB)的患者357例,SLN转移阳性患者行腋窝淋巴结清除(axillary lymph node dissection,ALND)。分析肿瘤T分期、分子分型与SLN转移的相关性,以及术前B超判断乳腺癌ALN转移的诊断价值。结果SLN总体转移率21.0%(75/357);T1与T2期患者SLN转移率分别为20.6%(40/194)和23.7%(27/114),SLN转移与肿瘤T分期无关,χ2=1.23,P=0.54;Luminal A-like型、Luminal B-like〔人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阴性〕型、Luminal B-like(HER2阳性)型、HER2过表达型和三阴型患者SLN转移率分别为35.0%(14/40)、17.6%(25/142)、25.6%(10/39)、22.2%(8/36)和14.3%(4/28),SLN的转移与肿瘤分子分型无相关性,χ2=6.88,P=0.14;B超判断ALN转移的准确性为68.6%(245/357),敏感性为44.0%(33/75),特异性为75.2%(212/282),阳性预测值为32.0%(33/103),阴性预测值为83.5%(212/254),假阴性率为16.5%(42/254);当SLN转移阳性,B超判断ALN转移阳性患者的非SLN转移率明显高于B超判断转移阴性患者,非SLN转移率分别为72.7%(16/22)和14.3%(6/42),χ2=10.61,P=0.01;B超判断ALN转移阴性患者非SLN淋巴结转移负荷较低,均≤2枚。结论 T1、T2期乳腺癌SLN总体转移率为21.0%(75/357),其转移与肿瘤T分期和分子分型无关;B超可以较准确判断ALN的转移状态;B超判断ALN转移阴性实际转移阳性患者仅有较低的淋巴结转移负荷。
Objective With the continuous improvement of the diagnostic rate of early breast cancer, the metastasis rate of axillary lymph node (ALN) in breast cancer is decreasing. This study retrospectively studied the diagnostic value of ultrasound in the diagnosis of ALN metastasis of breast cancer and analyzed the factors related to the metastasis of sentinel lymph node (SLN) in breast cancer. METHODS: A total of 357 patients with sentinel lymph node biopsy (SLNB) undergoing primary breast cancer at 377 Hospital of People’s Liberation Army from January 2009 to January 2013 were enrolled in this study. Axillary lymph node dissection (axillary lymph node dissection, ALND). To analyze the correlation between tumor T staging, molecular typing and SLN metastasis, and to evaluate the diagnostic value of preoperative ultrasound in the diagnosis of ALN metastasis of breast cancer. Results The overall SLN metastasis rate was 21.0% (75/357). The SLN metastasis rates were 20.6% (40/194) and 23.7% (27/114) in T1 and T2 stages respectively. The SLN metastasis was not related to tumor T stage (χ2 = 1.23 , P = 0.54; Luminal A-like, Luminal B-like [human epidermal growth factor receptor 2 (HER2) negative], Luminal B-like (HER2 positive), HER2 overexpression The rates of SLN metastasis were 35.0% (14/40), 17.6% (25/142), 25.6% (10/39), 22.2% (8/36) and 14.3% (4/28) , The correlation between SLN metastasis and tumor molecular typing was not significant (χ2 = 6.88, P = 0.14). The accuracy of B-ultrasound in detecting ALN metastasis was 68.6% (245/357) and the sensitivity was 44.0% (33/75) The positive predictive value was 32.0% (33/103), the negative predictive value was 83.5% (212/254), the false negative rate was 16.5% (42/254) The non-SLN metastasis rate of patients with positive ALN metastasis was significantly higher than that of patients with negative ALT metastasis (72.7% (16/22) and 14.3% (6/42), respectively) = 0.01; B-ultrasound to determine ALN metastasis negative patients with low SLN lymph node metastasis load were less than 2 pieces. Conclusion The overall rate of SLN metastasis of T1 and T2 breast cancer is 21.0% (75/357). The metastasis of the SLN is not related to the T stage and molecular type of tumor. B-ultrasound can judge the metastatic status of ALN more accurately. Patients with positive metastasis have only a lower burden of lymph node metastases.