常规超声联合超声造影术前评估乳腺癌患者腋窝淋巴结的诊断价值

杜丽雯; 巩海燕; 邓晶; 王慧; 易春蓓; 栗翠英

doi:10.19732/j.cnki.2096-6210.2020.04.011

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常规超声联合超声造影术前评估乳腺癌患者腋窝淋巴结的诊断价值

论著 | 更新时间：2025-12-15

- 常规超声联合超声造影术前评估乳腺癌患者腋窝淋巴结的诊断价值
- Preoperative evaluation of axillary lymph nodes in breast cancer patients with conventional ultrasound combined contrast-enhanced ultrasound
- 肿瘤影像学 2020年29卷第4期页码：397-405
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- DOI：10.19732/j.cnki.2096-6210.2020.04.011
  中图分类号：
- 网络出版：2020-08-28，
  
  纸质出版：2020-08-28
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杜丽雯,巩海燕,邓晶,等. 常规超声联合超声造影术前评估乳腺癌患者腋窝淋巴结的诊断价值[J]. 肿瘤影像学, 2020, 29(4): 397-405 https://doi.

org/10.19732/j.cnki.2096-6210.2020.04.011
杜丽雯,巩海燕,邓晶,等. 常规超声联合超声造影术前评估乳腺癌患者腋窝淋巴结的诊断价值[J]. 肿瘤影像学, 2020, 29(4): 397-405 https://doi. DOI： 10.19732/j.cnki.2096-6210.2020.04.011.

org/10.19732/j.cnki.2096-6210.2020.04.011 DOI：

摘要

目的：

比较常规超声（灰阶超声、彩色多普勒超声）及超声造影（contrast-enhanced ultrasound，CEUS）在乳腺癌患者腋窝淋巴结诊断中的价值，并将常规超声和CEUS相联合，评估联合诊断的价值。

方法：

回顾并分析234例乳腺癌患者术前腋窝淋巴结超声声像图，包括常规超声和CEUS特征。测量并记录不同检查方法的超声声像图特征和参数。采用t检验、

检验、受试者工作特征（receiver operating characteristic，ROC）曲线和logistic回归分析不同超声检查方法及参数。

结果：

多因素logistic回归分析结果显示淋巴结皮质厚度是诊断转移性腋窝淋巴结最准确的参数［

＜0.001，曲线下面积（area under curve，AUC）=0.808］；淋巴结灰阶分型（

＜0.001，AUC=0.786）、血流模式分型（

＜0.001，AUC=0.773）、增强模式（

＜0.001，AUC=0.662）在鉴别良恶性淋巴结中差异有统计学意义。淋巴门结构消失、非淋巴门型血流和阻力指数（resistance index，RI）0.7诊断转移性淋巴结具有较高的特异度（97.7%、94.6%、98.4%），但灵敏度低（31.7%、59.6%、26.0%）。常规超声检查诊断转移性淋巴结灵敏度、特异度、AUC分别为93.3%、66.2%、0.797；CEUS诊断转移性淋巴结灵敏度、特异度、AUC分别为46.2%、86.2%、0.662。常规超声联合CEUS显示灵敏度、特异度、AUC分别为96.2%、59.2%、0.777。比较常规超声和常规超声联合CEUS这两种方法差异无统计学意义（

=0.146）。

结论：

常规超声对乳腺癌患者腋窝淋巴结鉴别诊断有一定的意义。CEUS作为辅助检查方法无法提高常规超声诊断价值。

Abstract

Objective:

To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with the con-vent

ional ultrasound (US) including color Doppler flow and grey-scale US of breast cancer in predicting metastatic axillary lymph nodes in breast cancer patients.

Methods:

The conventional US and CEUS features of axillary nodes of 234 patients were retrospect-tively analysed. Different US patterns and parameters were evaluated. The correlation of US patterns and parameters with prognostic factors was analysed with the t test

chi-squared tests

receiver operating characteristic (ROC) curve and logistic regression analysis.

Results:

Multivariate logistic regression analysis showed that cortical thickness was the most accurate parameter for diagnosing malignant axillary lymph nodes ［

＜0.001

area under curve (AUC)=0.808］. Lymph node types of grey-scale US (

＜0.001

AUC=0.786)

vascular pattern (

＜0.001

AUC=0.773)

enhancement pattern (

＜0.001

AUC=0.662) was statistically significant in identifying benign and malignant lymph nodes. Absence of hilum

non-perihilar vessel and resistance index (RI) 0.7 has high specificity in diagnosing metastatic lymph nodes (97.7%

94.6%

98.4%)

but low sensitivity (31.7%

59.6%

26.0%). The sensitivity

specificity and AUC of conventional US in the diagnosis of metastatic lymph nodes were 93.3%

66.2% and 0.797. The sensitivity

specificity and AUC of CEUS in the diagnosis of metastatic lymph nodes were 46.2%

86.2% and 0.662

respectively. Convention-al US combined with CEUS showed a sensitivity of 96.2%

a specificity of 59.2%

and an AUC of 0.777 in identifying benign andmalignant lymph nodes. There was no significant difference between conventional US and conventional US combined with CEUS (

=0.146).

Conclusion:

Conventional US has a certain significance in the diagnosis of axillary lymph nodes in patients with breast cancer. As an auxiliary method

CEUS cannot improve the accuracy of conventional US.

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