超声、增强CT与增强MRI在乳腺癌腋窝淋巴结转移中的诊断价值比较

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[摘要] 目的 評估和比较超声、增强CT、增强MRI以及三种方法联合诊断对乳腺癌患者腋窝淋巴结转移的术前诊断及临床应用价值。 方法 选取2017年1月～2018年6月于我院经病理确诊的女性乳腺癌患者105例，术前均行乳腺超声、腋窝增强CT以及乳腺增强MRI检查，以淋巴结病理检查结果为金标准，对比分析影像检查结果与术后病理。 结果 105例乳腺癌患者中，经术后病理证实共有59例患侧腋窝淋巴结转移。超声、增强CT、增强MRI和联合诊断的灵敏度分别为71.2%、84.7%、57.6%、88.1%;特异度分别为65.2%、76.1%、78.3%、56.5%;阳性预测值分别为72.4%、82.0%、77.3%、72.2%;阴性预测值分别为63.8%、79.5%、59.0%、78.8%;准确性分别为68.6%、81.0%、66.7%、74.3%。其中增强CT的灵敏度和准确性高于超声及增强MRI（P=0.005，P=0.043）;联合诊断的灵敏度（88.1%）分别高于超声（71.2%）和增强MRI（57.6%）（P=0.022，P=0.000）;联合诊断特异度（56.5%）分别低于增强CT和增强MRI（P=0.047，P=0.026）。 结论 虽然增强CT的灵敏度和准确性均高于超声和增强MRI，但术前评估乳腺癌患者腋窝淋巴结状态时，应综合运用超声、增强CT及增强MRI等影像学检查，才能决定最适合患者的治疗方案。

[关键词] 乳腺癌;增强CT;超声;增强MRI;腋窝淋巴结转移

[中图分类号] R737.9          [文献标识码] B          [文章编号] 1673-9701（2019）07-0094-05

[Abstract] Objective To evaluate and compare the diagnostic and clinical value of ultrasound， enhanced CT， enhanced MRI and their combination in preoperative diagnosis of axillary lymph node metastasis of breast cancer. Methods 105 female patients with breast cancer diagnosed in our hospital from January 2017 to June 2018 were selected. All patients were given breast ultrasound， axillary enhanced CT， and breast enhanced MRI before operation. The results of lymph node pathological examination were used as the gold standard. The imaging results and postoperative pathology were compared. Results Among the 105 patients with breast cancer， a total of 59 patients were confirmed with axillary lymph node metastasis by postoperative pathology. The sensitivity of ultrasound， enhanced CT， enhanced MRI and combined diagnosis was 71.2%， 84.7%， 57.6%， and 88.1%， respectively; the specificity was 65.2%， 76.1%， 78.3%， and 56.5%， respectively; the positive predictive value was 72.4%， 82.0%， 77.3%， and 72.2%， respectively; the negative predictive value was 63.8%， 79.5%， 59.0%， and 78.8%， respectively; the accuracy was 68.6%， 81.0%， 66.7%， and 74.3%， respectively. The sensitivity and accuracy of enhanced CT were higher than those of ultrasound and enhanced MRI （P=0.005， P=0.043）; the sensitivity of combined diagnosis（88.1%） was higher than those of ultrasound （71.2%） and enhanced MRI（57.6%）， respectively（P=0.022， P=0.000）; the specificity of combined diagnosis（56.5%） was lower than those of enhanced CT and enhanced MRI（P=0.047， P=0.026）. Conclusion Although the sensitivity and accuracy of enhanced CT are higher than those of ultrasound and enhanced MRI， preoperative evaluation of axillary lymph node status in breast cancer patients should use combined imaging techniques such as ultrasound， enhanced CT and enhanced MRI to determine the most suitable therapy for patients.