文章摘要
徐燕军,邓一帆,胡兵,胡滨.二维超声联合实时组织弹性成像鉴别诊断乳腺癌腋窝淋巴结转移的价值[J].声学技术,2021,40(3):370~375
二维超声联合实时组织弹性成像鉴别诊断乳腺癌腋窝淋巴结转移的价值
The value of two-dimensional ultrasonography combined with modified real-time tissue elastography to evaluate the axillary lymph node metastasis of breast cancer1
投稿时间:2020-07-30  修订日期:2020-09-09
DOI:10.16300/j.cnki.1000-3630.2021.03.012
中文关键词: 乳腺癌  腋窝淋巴结  二维超声  实时组织弹性成像
英文关键词: breast cancer  axillary lymph nodes  two-dimensional ultrasonography  real-time tissue elastography (RTE)
基金项目:
作者单位E-mail
徐燕军 上海交通大学附属第六人民医院超声医学科, 上海 200233  
邓一帆 上海交通大学附属第六人民医院超声医学科, 上海 200233  
胡兵 上海交通大学附属第六人民医院超声医学科, 上海 200233  
胡滨 复旦大学附属闵行医院超声科, 上海市闵行区复旦医教研协同发展研究院, 上海 201199 niuniuhu1213@qq.com 
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中文摘要:
      目的:评估腋窝淋巴结有无转移对乳腺癌患者的分期和治疗起着至关重要的作用。建立实时弹性成像评分法和二维超声评估乳腺癌患者腋窝淋巴结有无转移的改良评分系统。方法:对纳入的已确诊的92例乳腺癌患者的97个可疑腋窝淋巴结进行二维超声和实时组织弹性超声检查。二维超声基于5个特征,分别为淋巴结短径、长短径比(L/S)、边界、皮质厚度和淋巴门长轴长度与淋巴结长径比(H/L),通过分数总和进行评估。实时组织弹性成像(Real-TimeTissue Elastography,RTE)分为有无淋巴门结构进行5分法评估,评分基于淋巴结内低回声区硬度信息的分布及其所占百分比。联合诊断通过将二维评分和RTE评分相加得出,并测量弹性应变比。以病理结果为金标准,通过受试者工作特征曲线分析各检查方法的诊断性能。结果:研究共纳入97例腋窝肿大淋巴结的病理结果,其中52例(53.6%)诊断为转移性,其他45例(46.4%)诊断为良性。二维超声的敏感性、特异性和准确性分别为92%、73%和83%;RTE分别为78%、93%、86%;联合诊断评估分别为88%、96%和92%;应变比分别为87%、76%和81%。二维超声检查比RTE灵敏度更高(92% vs 78%,P=0.039),而RTE的特异性优于二维超声检查(93% vs 73%,P=0.012)。联合诊断具有最高的曲线下面积(Area Under the Curve,AUC)为0.963,因此诊断效能最高。结论:RTE评估腋窝淋巴结有无转移具有高度的特异性,并且在与二维超声结合使用时可以大大提高诊断准确性。
英文摘要:
      Objective: To compare the diagnostic efficacy of two-dimensional (2D) ultrasonography and to modify realtime tissue elastography (RTE) scoring method for suspected axillary lymph node metastasis of breast cancer patients. Methods: Elastosonography and 2D ultrasonography were performed on 97 suspected axillary lymph nodes of 92 confirmed breast cancer patients. Scores of sizes, long-to short-axis ratio (L/S), cortical thickness, and lymph node hilum (H/L) were summed as the score of each lymph node at 2D ultrasonography, while a five-point scale was adopted for RTE scoring. The RTE evaluation method is determined based on the percentage and distribution of the hypoechoic regions in the lymph nodes, and is divided into the presence or absence of lymphatic portal structure for 5-point evaluation. The combined score of each lymph node was obtained by summing the score at 2D ultrasonography and that at RTE scoring. The strain ratio (SR) was calculated by comparison of the average strain of the lymph node with that of the surrounding tissue at the same depth. Diagnostic efficacies of 2D ultrasonography, RTE, the combined method and SR were compared through the receiver operating characteristic curve (ROC). Results: There were 97 axillary lymph nodes, including 45 non-metastatic (46.4%) and 52 metastatic nodes (53.6%). The sensitivity, specificity and accuracy of two-dimensional ultrasound were 92%, 73% and 83% respectively; RTE were 78%, 93% and 86% respectively; combined diagnostic assessments were 88%, 96% and 92% respectively; and the strain ratios are 87%, 76% and 81%, respectively. Two-dimensional ultrasound was more sensitive than RTE (92% vs 78%, P = 0.039), while the specificity of RTE was superior to two-dimensional ultrasound (93% vs 73%, P = 0.012). The combined diagnosis had the highest area under the curve (AUC = 0.963), so the diagnostic efficiency was the highest. Conclusion: RTE is highly specific for evaluating the presence or absence of axillary lymph node metastasis. Combined application of 2D ultrasonography with elastosonography can improve the diagnostic efficacy for metastatic axillary lymph node in breast cancer.
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