| Objective To investigate the value of the color Doppler ultrasonic diagnosis for metastasis of axillary lymph nodes in breast cancer before operation.Methods ⑴The color Doppler ultrasonography was undertaken before pathologic examination to detect 280 patients of axillary metastatic lymph nodes with breast carcinoma. A total of 154 patients with axillary lymph nodes were showed by ultrasonography. They were classified into two groups according to the postoperative pathology of radical mastectomy. One group consisted of all women who had metastasis of axillary lymph nodes;the other had no metastasis of axillary lymph nodes. The ultrasonographic features observed included the maximum dimension,the long-short axis ratio,the cortex-hilum thickness ratio and the flow pattern of axillary lymph nodes on the longitudinal section. The features were analysed univariately to find out the interrelated factors of breast lymph nodes metastasis. The receiver operating characteristic curve(ROC)analysis was done to determine sensitivity and specificity of individual ultrasonographic features in distinguishing metastatic lymph nodes from the healthy one. ⑵ Using high-frequency two-dimensional ultrasonography combined with color Doppler flow imaging technology, were retrospectively analyzed lymph node ultrasonographic and blood flow distribution in 154 breast cancer patients with axillary lymph node, and then adopt the method of digital subtraction angiography for display, closely observe lymph nodes with or without internal blood flow signal and internal vascular distribution characteristics of lymph nodes, at the same time take the pulse Doppler sampling analysis, adjust the Angle of incidence and blood flow velocity blood flow, the Angle is less than 60 °, artery blood flow spectrum characteristics, detecting that the highest rate of artery blood flow velocity and blood flow resistance index. If there are multiple lymph node enlargement, should continue to scan at least three or more, the high frequency ultrasound blood flow dynamics parameters gained by the average value is calculated; According to the results of the clinical palpation examination by high frequency color doppler ultrasound and lymph nodes can be divided into two groups, namely normal lymph node groups and malignant metastasis of lymph nodes. ⑶According to postoperative pathological detection standards, analysis of true positive, negative and false positive and false negative indicators, analysis and calculation palpate diagnosis and the sensitivity, specificity and diagnostic accuracy of ultrasound diagnosis, and compare the ultrasonic diagnosis of the sensitivity of different number of axillary nodes.Results ⑴The maximum dimension of axillary lymph nodes in the metastasis group was 19. 8 ± 6. 9 mm and 18. 6 ±6.3 mm in the other group. It was not statistically significant in the maximum dimension lymph nodes(P > 0. 05). ⑵ The long-short axis ratio were 1.1 ~ 2. 7and the cortex-hilum thickness ratio were 1.0 ~ 4.2 in axillary lymph nodes of the metastasis group; the two ratio were 1.1 ~ 4. 2 and 0.1 ~ 1.9 in the other group. The long-short axis ratio,the cortex-hilum thickness and the flow pattern of axillary lymph nodes of the two groups were statistically significant factors(P <0. 05). A total of 46.8%of metastatic axillary lymph nodes were peripheral flow and 25.5%of metastatic axillary lymph nodes were mixed type flow. And 19.1%of metastases axillary lymph nodes were central flow. By ROC curve analysis,the sensitivity and specificity were 63.8% and62.9% based on the criteria of the long-short axis ratio≤2.0,the sensitivity and specificity were76. 4% and 87.8%based on the criteria of the cortex-hilum thickness ratio≥1.0. ⑶Transfer of axillary lymph node internal blood flow distribution type is visible to the following four types:(1) peripheral type(44 cases)(2) the central type(18 cases)(3) dispersible(8 cases)(4) hybrid(24 cases); when there is no transfer of axillary lymph nodes, visible to the blood flow distribution types:(1) dispersible type(5 cases)(2)peripheral type(11 cases)(3) the central type(37 cases)(4) hybrid type(7 cases). Axillary lymph nodes without metastasis group, blood flow to the central type distribution types, accounted for 61.7%, followed by peripheral blood flow distribution types, accounted for 18.3%(11/60);Transfer of axillary lymph nodes, peripheral accounted for 46.8%, hybrid accounted for 25.5%; Peripheral blood flow distribution types of mixed type is as high as 72.3%, to achieve a higher level. The blood flow signals in group of axillary lymph node rate is as high as 91.5%; There were 86 positive cases in preoperative diagnosis of metastatic lymph nodes to confirm by postoperative pathology and according to the high frequency color Doppler ultrasound examination; there were 8 false positive cases. The false positive sensitivity was 91.5%; there were 53 true negative cases and there were 7 false negative cases confirmed by pathology.The specificity was 88.3%,and the accuracy was 90.3%. After statistics analysis, the diagnostic sensitivity, specificity and accuracy was difference significant by the color doppler ultrasound and clinical touch in terms of predicting axillary lymph nodes if there is a transfer.(P < 0.01). There were 48 cases with axillary metastasis lymph nodes in 108 clinical touch negative patients, the palpation hidden rate was 44.4%. The high frequency color Doppler can detect 41 cases in it. The metastasis rate was 85.4% to detect occult lymph node.Conclusion ⑴It can significantly improve diagnostic accuracy if we can select the long-short axis ratio ≤2.0 and / or the cortex-hilum thickness ratio≥1.0; and it is necessary to learn the clinical breast cancer staging and surgical way carries by ultrasonic diagnosis for metastasis of axillary lymph nodes in breast cancer. ⑵After statistics analysis, the diagnostic sensitivity, specificity and accuracy was difference significant by the color Doppler ultrasound and clinical touch in terms of predicting axillary lymph nodes if there is a transfer. The high frequency color Doppler ultrasound can find palpate the negative transfer of occult lymph node ratio is 85.4%, so that the clinical detection of lymph node hidden rate 44.4% by palpation inspection to high frequency color to exceed 10.3% of detection. |
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