| Breast cancer has become the world’s highest incidence malignant tumors in women,Axillary lymph node(ALN)status is the most important factors influencing the treatment and prognosis,Therefore,It is very important to diagnosis of ALN correctly.Traditionally,the most reliable method is axillary lymph node dissection,sentinel lymph node biopsy replaced axillary lymph node dissection associated with traumatic and postoperative complications gradually,But,It is still a surgical procedure.Therefore how to preoperative noninvasive accurate assessment of ALN is very important,It has been the hotspot of domestic and foreign research.The aim of this study was to provide a comprehensive and multivariate analysis of ultrasound and magnetic resonance imaging(MRI)and comparative evaluation in order to search for reliable noninvasive diagnostic method and to improve diagnostic efficacy.188 breast cancer patients of which 2 patients with bilateral lesions were assessed from April,2015 to August,2016 in the 307 th Hospital of Military Chinese People’s Liberation Army,190 cases of ipsilateral ALNs were under ultrasound examination,including 127 cases with metastatic and 63 cases without metastatic confirmed in postoperative pathological results.Long to short diameter ratio(L/S),Whether the form is rule,cortical thickness and whether the hilum of lymph node exist were monitored from two-dimensional ultrasound(2D-US),type and grade of blood flow,peak systolic velocity(PSV)and resistance index(RI)were received in color doppler flow imaging;elasticity score and elastic strain rate(SR)were recorded from ultrasound elastography(UE).Taking the postoperative pathological results as standard,ROC curve were performed to analyse the role of UE in 2D-US classification,Chi-square was used to estimate each single factor of conventional ultrasound and UE,Binary logistic regression analysis were performed to analyze the factors and regression model was established,ROC curve was used to evaluate the diagnostic efficiency of regression model.60 cases of ALNs were comparative analysised in diagnosis of ultrasonography and MRI used body coil combined with breast coil in coronal scanning,34 cases had metastasis,26 cases were benign,lymph node long diameter,short diameter,internal signals,contour edge and shape were observed from thin layer reconstruction in workstation,chi-square test was used to analyze the value of body coil and MRI factors,Kappa statistics were calculated to assess the consistency of various factors and pathological results,Z test was used to compare the area under ROC curve of conventional ultrasound,UE and MRI.The research findings as follows,UE in 2D-US lymph node classification depends on the cortical thickness and the hilum of lymph node played an importan role in diagnosis of ALNs,The Area under ROC curve of 2D-US classification and combination of UE was 0.742,0.869,respectively,The comparison between them was statistically significant(P<0.05);the results of ultrasounic single factor analysis showed that L/S,morphology,cortical thickness and hilum of lymph node,type of blood flow,PSV,RI,elasticity score and SR were significant factors,but there was no signifcant difference in grade of blood flow of lymph node(P>0.05),binary logistic regression was used to analyze 8 related factors,type of blood flow,elasticity score and SR were included in the regression model,The odd ratio value was 5.896,10.272,9.729 respectively,95% CI was 1.214~28.642,1.805~58.461,1.751~54.072,separately,The regression model was Logist(P)=-2.221+1.774X4+2.329X7+2.275X8,The sensitivity and specificity of the model diagnosis in ALNs was 93.75%,88.7%,respectively,The ROC was drawn and the area under ROC curve was 0.952(S.E.=0.015,P<0.001,95% CI: 0.922~0.982),This model had a good fit and can be used for analysis of ALNs.It is helpful in the detection and evaluating ALNs with combination of the body coil and the breast coil in MRI coronal scan,there was significant difference in the detection of ALNs between the two groups.Short diameter>10mm,L/S,whether the internal signal is uniform,edge,whether shape is circular or not were related factors in diagnosis of ALNs in MRI,kappa value was 0.321,0.225,0.607,0.435,0.485 respectively;The Area under ROC curve of Conventional ultrasound,UE and MRI in diagnosis of ALNs was 0.781,0.937,0.834 respectively,There were statistically significant in the value of UE compared with Conventional Ultrasound and MRI(p<0.05),Body coil combined with breast coil of coronary scanning applied in MRI improved the diagnostic of Conventional Ultrasound,But there was no statistically significance between them(P>0.05).In conclusion,UE has a good value in diagnosis of ALNs in breast cancer,combined with conventional ultrasound multi-factor comprehensive analysis can improve the diagnostic efficiency;The application of body coil in dissection of ALN has certain clinical significance,which can make up for the deficiency of breast coil alone in ALNs scanning and diagnostic;Ultrasound and MRI provide a good value for clinical noninvasive evaluation of ALN in order to reduce unnecessary sentinel lymph node biopsy and play an important part for guiding clinical treatment. |
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