| Purpose:This study through the analysis of the preoperative ultrasound acoustic image characteristics of patients with breast cancer and different types of tumor markers level relations with axillary lymph node metastasis,To evaluate the significance of ultrasonography combined with serum tumor marker detection in guiding intraoperative axillary management and postoperative comprehensive treatment.Method:Collect between September 2018 and May 2020,88 cases in the fifth affiliated hospital of zhengzhou university breast cancer clinical pathological data of the patients with modified radical.According to the postoperative pathological diagnosis,the patients were divided into axillary lymph node metastasis group and no metastasis group.Preoperative application of color doppler ultrasound mammary gland and axillary lymph nodes,record primary tumor of breast cancer and axillary lymph nodes of ultrasonic acoustic image characteristics.Chi-square test was used to analyze the correlation between the acoustic features and axillary lymph node metastasis.Serum cytokeratin 19(CK19)and carcinoembryonic antigen(CEA)expression were determined by electrochemiluminescence,The serum concentrations and positive rates of CK19 and CEA were compared between the axillary lymph node metastasis group and the non-metastasis group.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficacy of CK19 and CEA in predicting axillary lymph node metastasis of breast cancer;CK19 were,CEA as independent variables,establish a Logistic regression model.The three preoperative examinations adopt the method of parallel test,that is,any one of the indicators is positive,then the result of the combined test is determined to be axillary lymph node metastasis.In terms of pathological diagnosis as the gold standard,ultrasonic,CK19 were,CEA detection and combined detection for the diagnosis of axillary lymph node metastasis of sensitivity,specificity,accuracy,positive and negative predictive value.Result:1.Ultrasound examination results of axillary lymph nodes showed that the detection rate of lymph node diameter≥7mm,unclear boundary,uneven internal echo,rich blood flow signal,and ratio of aspect to diameter < 2 in axillary lymph node metastasis group were all higher than those in non-metastasis group,with statistical significance(P<0.05).2.Ultrasound examination results of primary breast cancer tumor showed that the detection rate of mass diameter≥2cm,unclear boundary,rich blood flow signal,high echo halo and microcalcification in axillary lymph node metastasis group was significantly higher than that in the group without axillary lymph node metastasis,with statistical significance(P<0.05).3.The serum levels and positive rates of CK19 and CEA were compared between the axillary lymph node metastasis group and the non-metastasis group,Serum levels and positive rates of CK19 and CEA in axillary lymph node metastasis group were higher than those in non-metastasis group,with statistical significance(P<0.05).4.The ROC curve results showed that the area under the ROC curve(AUC)of CK19 was 0.733(95%CI0.676～0.870)and that of CEA was 0.797(95%CI0.705～0.889).The AUC of CK19 and CEA combined detection was 0.841(95%CI0.716-0.921).The AUC of the combined test was greater than that of CK19 and CEA alone.Taking CK19 and CEA as independent variables,a Logistic regression model was established: Logit(P)=-3.403+0.125×CK19+0.171×CEA.5.The sensitivity,specificity,positive and negative predictive values and accuracy of CK19 in the diagnosis of axillary lymph node metastasis were 79.17%,72.50%,77.55%,74.35% and 76.14%,respectively.CEA were 83.33%,65.00%,74.07%,76.47%,75.00%;Ultrasound was 81.25%,85.00%,86.67%,79.07%,82.95%;The combined detection rates of the three were 95.83%,70.00%,79.31%,93.33%,84.09%.The sensitivity of CEA was 83.33%,The highest ultrasound specificity and accuracy are 85.00% and 82.95% respectively.The sensitivity and accuracy of the three combined tests were 95.83% and 84.09%,both higher than any single test.Conclusion:1.The analysis of ultrasonographic characteristics of primary breast cancer mass and axillary lymph node has good application value for preoperative diagnosis of axillary lymph node.2.The expression level and positive rate of serum tumor markers CK19 and CEA were correlated with axillary lymph node metastasis of breast cancer.3.On the basis of color Doppler ultrasound screening,the combined detection of serum tumor markers CK19 and CEA can improve the sensitivity and accuracy of diagnosis,and has a higher clinical application value in predicting axillary lymph node metastasis of breast cancer. |
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