乳腺癌患者腋窝转移性与非转移性淋巴结的分类：超声下皮质-门部面积比的价值。

Classification of Metastatic versus Non-Metastatic Axillary Nodes in Breast Cancer Patients: Value of Cortex-Hilum Area Ratio with Ultrasound.

机构信息

Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.

出版信息

J Breast Cancer. 2012 Mar;15(1):65-70. doi: 10.4048/jbc.2012.15.1.65. Epub 2012 Mar 28.

DOI:10.4048/jbc.2012.15.1.65

PMID:22493630

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3318176/

Abstract

PURPOSE

To investigate the significance of the cortex-hilum (CH) area ratio and longitudinal-transverse (LT) axis ratio and the blood flow pattern for diagnosis of metastatic axillary lymph nodes by ultrasound in breast cancer patients.

METHODS

From October 2005 to July 2006, we prospectively evaluated axillary nodes with ultrasound in 205 consecutive patients who had category 4B, 4C or 5 breast lesions according to the Breast Imaging Reporting and Data System-Ultrasound (BI-RADS-Ultrasound®). Among the 205, there were 24 patients who had pathologic verification of breast cancer and axillary lymph node status. For a total of 80 axillary nodes we measured the areas of the cortex and hilum of lymph nodes and calculated the area ratio. We also measured the length of the longitudinal and transverse axis of the lymph nodes and calculated the length ratio. We evaluated the blood flow pattern on power Doppler imaging and classified each lymph node into a central or peripheral pattern. Diagnostic performance was analyzed according to positive criteria for lymph node metastasis (CH area ratio >2, LT axis ratio <2, peripheral type on power Doppler imaging).

RESULTS

The sensitivity of the CH area ratio was superior to that of the LT axis ratio (94.1% vs. 82.3%, p=0.031) and to that of the blood flow pattern (94.1% vs. 29.4%, p=0.009). For specificity, all three evaluating parameters had high values (89.1-95.6%) and no significant differences were found (p=0.121). The CH area ratio had a better positive predictive value than the LT axis ratio (94.1% vs. 80.0%, p=0.030) and power Doppler imaging (94.1% vs. 66.6%, p=0.028). For the negative predictive value, the CH area ratio was superior to the LT axis ratio (95.6% vs. 86.6%, p=0.035) and the blood flow pattern (95.6% vs. 63.0%, p=0.027).

CONCLUSION

We recommend the CH area ratio of an axillary lymph node on ultrasound as a quantitative indicator for the classification of lymph nodes. The CH area ratio can improve diagnostic performance when compared with the LT axis ratio or blood flow pattern.

摘要

目的

通过超声检查，探讨乳腺癌患者腋窝淋巴结皮质-门（CH）面积比和纵横（LT）轴比以及血流模式对诊断转移性腋窝淋巴结的意义。

方法

2005 年 10 月至 2006 年 7 月，我们前瞻性评估了 205 例连续患者的腋窝淋巴结，这些患者根据乳腺影像报告和数据系统-超声（BI-RADS-Ultrasound®）分类为 4B、4C 或 5 类乳腺病变。在这 205 例患者中，有 24 例患者经病理证实为乳腺癌和腋窝淋巴结状态。我们共测量了 80 个腋窝淋巴结的皮质和门区面积，并计算了面积比。我们还测量了淋巴结的长轴和短轴长度，并计算了长度比。我们在能量多普勒成像上评估血流模式，并将每个淋巴结分为中央型或周围型。根据淋巴结转移的阳性标准（CH 面积比>2、LT 轴比<2、能量多普勒成像上的周围型）分析诊断性能。

结果

CH 面积比的敏感性优于 LT 轴比（94.1%对 82.3%，p=0.031）和血流模式（94.1%对 29.4%，p=0.009）。特异性方面，所有三个评估参数均具有较高的值（89.1%-95.6%），且差异无统计学意义（p=0.121）。CH 面积比的阳性预测值优于 LT 轴比（94.1%对 80.0%，p=0.030）和能量多普勒成像（94.1%对 66.6%，p=0.028）。阴性预测值方面，CH 面积比优于 LT 轴比（95.6%对 86.6%，p=0.035）和血流模式（95.6%对 63.0%，p=0.027）。