超声联合诊断评估乳腺癌淋巴结转移的临床价值
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摘要
目的探究常规超声、超声造影以及弹性成像联合诊断在术前评估乳腺癌淋巴结转移的临床价值。方法根据乳腺癌术后的淋巴结病理结果将淋巴结分为转移组(n=61)和反应组(n=74);记录并比较两组常规超声征象、超声造影以及弹性成像数据。利用logistic回归生成不同指标联合的预测概率分布,并利用ROC曲线检验单独和联合诊断的效能。结果 L/S、淋巴门、峰值强度(PI)和弹性评分均对乳腺癌淋巴结转移的发生存在影响(P<0.05);L/S≤2对颈部淋巴结转移发生的影响最大(OR=31.017);PI、弹性评分、淋巴门、L/S联合诊断淋巴结转移的AUC为0.943,高于各指标单独诊断的AUC,差异有统计学意义(P<0.05)。联合诊断的拟合方程为logit(P)=-9.742+2.115×L/S+2.560×淋巴门+0.178×PI+1.940×弹性评分。结论联合常规超声征象、造影指标以及弹性成像数据可以提高诊断乳腺癌淋巴结转移的诊断效能。
Objective To explore the value of conventional ultrasound in combination with contrast-enhanced ultrasound and elastography in the preoperative diagnosis of breast cancer lymph node metastasis.Methods Lymph nodes were divided into a metastatic group(n=61) and response group(n=74) according to the lymph node pathological findings.The routine ultrasound features,contrast-enhanced ultrasound,and elastography data were recorded and compared.Logistic regression was used to generate a combination of the predictive probability distribution of different indicators,and ROC curve was used to test the efficacy of single indicator and combined indicators.Results L/S,lymphatic portal,peak intensity(PI),and elasticity score had an influence on the occurrence of breast cancer lymph node metastasis(P<0.05),and L/S≤2 had the greatest impact(OR=31.017).The AUC of the combination of PI,elasticity score,lymphatic portal and L/S in the diagnosis of lymph node metastasis was 0.943,which was higher than the AUC of every single indicator(P<0.05).The fitting equation for the combined diagnosis was logit(P)=-9.742+2.115×L/S+2.560×lymphatic portal+0.178×PI+1.940×elasticity score.Conclusion The combination of conventional ultrasound signs,contrast-enhanced ultrasound and elastography data for lymph node metastasis may improve the diagnostic efficiency of lymph node metastasis in breast cancer.
Objective To explore the value of conventional ultrasound in combination with contrast-enhanced ultrasound and elastography in the preoperative diagnosis of breast cancer lymph node metastasis.Methods Lymph nodes were divided into a metastatic group(n=61) and response group(n=74) according to the lymph node pathological findings.The routine ultrasound features,contrast-enhanced ultrasound,and elastography data were recorded and compared.Logistic regression was used to generate a combination of the predictive probability distribution of different indicators,and ROC curve was used to test the efficacy of single indicator and combined indicators.Results L/S,lymphatic portal,peak intensity(PI),and elasticity score had an influence on the occurrence of breast cancer lymph node metastasis(P<0.05),and L/S≤2 had the greatest impact(OR=31.017).The AUC of the combination of PI,elasticity score,lymphatic portal and L/S in the diagnosis of lymph node metastasis was 0.943,which was higher than the AUC of every single indicator(P<0.05).The fitting equation for the combined diagnosis was logit(P)=-9.742+2.115×L/S+2.560×lymphatic portal+0.178×PI+1.940×elasticity score.Conclusion The combination of conventional ultrasound signs,contrast-enhanced ultrasound and elastography data for lymph node metastasis may improve the diagnostic efficiency of lymph node metastasis in breast cancer.
引文
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[16] 周成香,刘亚斌,查晓霞,等.高频彩色多普勒超声对乳腺癌腋窝淋巴结性质的鉴别价值[J].现代生物医学进展,2017,17(13):2565-2568.
[17] Rubaltelli L,Khadivi Y,Tregnaghi A,et al.Evaluation of lymph node perfusion using continuous mode harmonic ultrasonography with a second-generation contrast agent[J].Journal of Ultrasound in Medicine:Official Journal of the American Institute of Ultrasound in Medicine,2004,23(6):829-836.
[18] Xu Y,Bai X,Chen Y,et al.Application of real-time elastography ultrasound in the diagnosis of axillary lymph node metastasis in breast cancer patients[J].Scientific Reports,2018,8(1):10234.
[2] Mcbride R,Hershman D,Tsai WY,et al.Within-stage racial differences in tumor size and number of positive lymph nodes in women with breast cancer[J].Cancer,2007,110(6):1201-1208.
[3] Sui WF,Chen X,Peng ZK,et al.The diagnosis of metastatic axillary lymph nodes of breast cancer by diffusion weighted imaging:a meta-analysis and systematic review[J].World Journal of Surgical Oncology,2016,14(1):155.
[4] Matsuzawa F,Omoto K,Einama T,et al.Accurate evaluation of axillary sentinel lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid in breast cancer:a preliminary clinical trial[J].SpringerPlus,2015,4:509-518.
[5] Sharma N,Cox K.Axillary nodal staging with Contrast-Enhanced ultrasound[J].Current Breast Cancer Reports,2017,9(4):259-263.
[6] Boone BA,Huynh C,Spangler ML,et al.Axillary lymph node burden in invasive breast cancer:a comparison of the predictive value of Ultrasound-Guided needle biopsy and sentinel lymph node biopsy[J].Clinical Breast Cancer,2015,15(5):e243-e248.
[7] Yeo SH,Kim GR,Lee SH,et al.Comparison of ultrasound elastography and color doppler ultrasonography for distinguishing small Triple-Negative breast cancer from fibroadenoma[J].Journal of Ultrasound in Medicine,2018,37(9):2135-2146.
[8] 董凤林.多模态超声成像在浅表淋巴结病变鉴别诊断及引导穿刺活检的临床研究[D].苏州:苏州大学,2017.
[9] Ghoncheh M,Pournamdar Z,Salehiniya H.Incidence and mortality and epidemiology of breast cancer in the world[J].Asian Pacific Journal of Cancer Prevention,2016,17(S3):43-46.
[10] Houssami N,Diepstraten SC,Cody IH,et al.Clinical utility of Ultrasound-Needle biopsy for preoperative staging of the axilla in invasive breast cancer[J].Anticancer Research,2014,34(3,SI):1087-1097.
[11] Wetzig N,Gill PG,Espinoza D,et al.Sentinel-Lymph-Node-Based management or routine axillary clearance?Five-Year outcomes of the RACS sentinel node biopsy versus axillary clearance(SNAC)1 trial:assessment and incidence of true lymphedema[J].Annals of Surgical Oncology,2017,24(4):1064-1070.
[12] Caudle AS,Yang WT,Krishnamurthy SA,et al.Improved axillary evaluation following neoadjuvant therapy for patients with Node-Positive breast cancer using selective evaluation of clipped nodes:implementation of targeted axillary dissection[J].Journal of Clinical Oncology,2016,34(10):1072-1078.
[13] Lowes S,Leaver A,Cox K,et al.Evolving imaging techniques for staging axillary lymph nodes in breast cancer[J].Clinical Radiology,2018,73(4):396-409.
[14] Li CX,Wen DH,Liu WL,et al.Study on the value of color Doppler ultrasound in evaluating the efficacy of neoadjuvant chemotherapy for breast cancer[J].Journal of Hainan Medical University,2016,22(9):100-103.
[15] 蒋蓓琦,章华,庄志刚.腋窝超声在乳腺癌前哨淋巴结活检中应用价值[J].中华临床医师杂志(电子版),2013(5):1975-1979.
[16] 周成香,刘亚斌,查晓霞,等.高频彩色多普勒超声对乳腺癌腋窝淋巴结性质的鉴别价值[J].现代生物医学进展,2017,17(13):2565-2568.
[17] Rubaltelli L,Khadivi Y,Tregnaghi A,et al.Evaluation of lymph node perfusion using continuous mode harmonic ultrasonography with a second-generation contrast agent[J].Journal of Ultrasound in Medicine:Official Journal of the American Institute of Ultrasound in Medicine,2004,23(6):829-836.
[18] Xu Y,Bai X,Chen Y,et al.Application of real-time elastography ultrasound in the diagnosis of axillary lymph node metastasis in breast cancer patients[J].Scientific Reports,2018,8(1):10234.