杜岚+杨敬春+常莹

[摘要] 目的 探討乳腺MRI与腋窝超声鉴别乳腺癌患者腋窝淋巴结转移的临床价值。 方法 选择2016年10月～2017年9月在首都医科大学宣武医院接受乳腺癌根治术、改良根治术或保乳根治术的229例患者资料进行回顾性分析。患者术前均接受乳腺MRI和腋窝超声检查，接受根治术治疗及腋窝淋巴结清扫术，术后常规行淋巴结病理检查，观察乳腺MRI和腋窝超声结果与术后病理结果的相关性。 结果 229例患者中，腋窝淋巴结转移102例，未见转移127例。MRI诊断腋窝淋巴转移108例，其中91例与病例符合，17例误诊，11例漏诊。腋窝超声诊断腋窝淋巴转移98例，与病理诊断符合80例，18例误诊，22例漏诊。MRI判定腋窝淋巴结转移的敏感度高于腋窝超声，差异有统计学意义（P < 0.05）；两者判定腋窝淋巴结转移的特异性和准确性差异无统计学意义（P > 0.05）。MRI阳性同时腋窝超声阳性判定腋窝淋巴结转移的特异性高于MRI、腋窝超声、MRI阳性或腋窝超声阳性（P < 0.05）；MRI阳性或腋窝超声阳性判定腋窝淋巴结转移的敏感度高于MRI、腋窝超声、MRI阳性同时腋窝超声阳性（P < 0.05）。 结论 乳腺MRI和腋窝超声均是检测乳腺癌淋巴结转移的重要手段，二者均阳性作为诊断标准有助于腋窝淋巴结转移确诊，二者之一阳性作为诊断标准有助于腋窝淋巴结转移排除，临床可根据实际情况灵活运用。

[关键词] 乳腺癌；腋窝淋巴结转移；核磁共振；彩色超声多普勒

[中图分类号] R73 [文献标识码] A [文章编号] 1673-7210（2017）12（b）-0168-04

[Abstract] Objective To study the clinical value of breast MRI and axillary ultrasonography in the differential diagnosis of axillary lymph node metastasis in breast cancer patients. Methods The data of 229 patients with breast cancer underwent radical mastectomy， modified radical mastectomy or radical mastectomy in Xuanwu Hospital from October 2016 to September 2017 were retrospectively analyzed. All patients underwent preoperative MRI and axillary ultrasound examination， underwent radical mastectomy and axillary lymph node dissection， and underwent routine pathological examination of lymph nodes. The correlation between MRI and axillary ultrasound findings and postoperative pathological findings were observed. Results Axillary lymph node metastasis was detected in 102 of 229 patients， and no metastasis was detected in 127 patients. 108 cases of axillary lymph node metastasis were detected by MRI， of which 91 cases were consistent with the cases， 17 cases were misdiagnosed， and 11 cases were missed. Axillary lymph node metastasis was detected in 98 cases by ultrasound， 80 cases were consistent with pathological diagnosis， 18 cases were misdiagnosed， and 22 cases were missed diagnosis. The sensitive of MRI in diagnosis of axillary lymph node metastasis was higher than that of axillary ultrasound， with statistically significant difference （P < 0.05）. There was significant difference in specificity and accuracy of diagnosis between MRI and axillary ultrasound （P > 0.05）. The specificity of MRI positive and axillary ultrasound positive in diagnosis of axillary lymph node metastasis was higher than that of MRI， axillary ultrasound and MRI positive or axillary ultrasound positive （P < 0.05）. The sensitivity of MRI positive or axillary ultrasound positive was higher than that of MRI， axillary ultrasound， MRI positive and axillary ultrasound positive （P < 0.05）. Conclusion The breast MRI and axillary ultrasonography are important means of detecting lymph node metastasis in breast cancer， both positive is helpful for the diagnosis of axillary lymph node metastasis， one positive in the two indicator is helpful for the diagnosis of axillary lymph node metastasis， clinical can flexibly according to the actual situation.endprint

[Key words] Breast cancer； Axillary lymph node metastasis； Magnetic resonance imaging； Color doppler ultrasound

乳腺癌居女性恶性肿瘤发病率第一位，腋窝淋巴结是乳腺癌常见的转移部位。明确腋窝淋巴结转移状态，对准确进行TNM分期，指导临床医师手术方式选择，术前及术后治疗方案制订，均具有重要指导意义[1-2]。研究显示，超过40%的乳腺癌有腋窝淋巴结转移，且有腋窝淋巴结患者10年生存率显著低于无腋窝淋巴结转移者，如何准确评价腋窝淋巴结状态已成为临床关注的重点[3-4]。超声是临床判定乳腺癌腋窝淋巴结转移的常用手段，通过腋窝超声就清晰显示转移病灶形态学特征、血流分布、血流动力学等变化，为腋窝淋巴转移提供准确的参考诊断[5-6]。……