摘要目的 探讨超微血管显像与常规灰阶超声联合用于乳腺癌腋窝淋巴结转移的诊断价值,为乳腺癌手术方式的选择及预后评估提供依据.方法 采用分层整群抽样回顾性分析的方法,抽取2016年5月至2019年4月于郑州市第九人民医院确诊为乳腺癌的患者50例,所有患者均接受常规二维灰阶超声检查、超微血管显像检查,以病理诊断结果为金标准,计算并对比超微血管显像与常规灰阶超声单独、联合应用的灵敏度、特异度、准确度、阴性预测值、阳性预测值,计算各检查方法与病理诊断的Kappa一致性指数.结果 腋窝淋巴结清扫后,淋巴结活检结果显示,50例乳腺癌患者中共检出50枚腋窝淋巴结,其中23枚发生转移,转移率为46.00％;常规灰阶超声检查对乳腺癌腋窝淋巴结转移的诊断灵敏度、特异度、准确度、阴性预测值、阳性预测值分别为69.57％、59.26％、64.00％、69.57％、59.25％,且与病理诊断结果的一致性Kappa指数为0.285;超微血管显像对乳腺癌腋窝淋巴结转移诊断的灵敏度、特异度、准确度、阴性预测值、阳性预测值分别为78.26％、74.07％、76.00％、80.00％、72.00％,且与病理诊断结果的一致性Kappa指数为0.520;联合检测对乳腺癌腋窝淋巴结转移诊断的灵敏度、特异度、准确度、阴性预测值、阳性预测值分别为86.96％、92.59％、90.00％、89.29％、90.91％,且与病理诊断结果的一致性Kappa指数为0.798;联合检查用于乳腺癌腋窝淋巴结转移鉴别诊断的灵敏度、特异度、准确度、阴性预测值、阳性预测值均高于二者单独应用,且联合检测Kappa一致性指数最高,其次为超微血管显像.结论 超微血管显像与常规灰阶超声在乳腺癌腋窝淋巴结转移的诊断中均有重要应用价值,二者联合应用有利于提高乳腺癌腋窝淋巴结转移的检出率,与病理诊断一致性高.

abstractsObjective To analyze the value and efficacy of ultramicro angiography combined with conventional gray-scale ultrasound in diagnosis of axillary lymph node metastasis in breast cancer. Methods The stratified cluster sampling retrospective analysis method was preformed in the study. Fifty patients with breast cancer diagnosed in the Ninth People's Hospital of Zhengzhou from May 2016 to April 2019 were enrolled. All the patients received conventional gray-scale ultrasound examination and ultramicro angiography. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of single ultramicro angiography, conventional gray-scale ultrasound and combination of the two methods were recorded and compared, with the pathological results as the gold standard. The Kappa consistency index of each examination method with pathological diagnosis was calculated. Results The results of lymph node biopsy after axillary lymph node dissection showed that 50 axillary lymph nodes were detected in 50 breast cancer patients, 23 of which metastasized, and the metastasis rate was 46. 00％. The diagnostic sensitivity, specificity, accuracy, negative predictive value and positive predictive value of conventional gray-scale ultrasound examination for axillary lymph node metastasis of breast cancer were 69. 57％, 59. 26％, 64. 00％, 69. 57％, 59. 25％, respectively, and the Kappa consistency index with pathological diagnostic results was 0. 285. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of ultramicro angiography in the diagnosis of breast cancer with axillary lymph node metastasis were 78. 26％, 74. 07％, 76. 00％, 80. 00％, 72. 00％, respectively, and the Kappa consistency index with pathological diagnostic results was 0. 520. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of combined examination in the diagnosis of breast cancer with axillary lymph node metastasis were 86. 96％, 92. 59％, 90. 00％, 89. 29％, 90. 91％, respectively, and the Kappa consistency index with pathological diagnostic results was 0. 798. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of combined examination in the differential diagnosis of breast cancer with axillary lymph node metastasis were higher than those of single examination, and the Kappa consistency index of combined examination was the highest, followed by ultramicro angiography. Conclusions Ultramicro angiography combined with conventional gray-scale ultrasound in differential diagnosis of breast cancer with axillary lymph node metastasis has important application values. However, the combined examination can further improve the detection rate of axillary lymph node metastasis in breast cancer, which has high consistency with pathological diagnosis.