标准乳腺MRI与腋窝超声鉴别乳腺癌有无转移及晚期腋窝淋巴结病变[摘要]目的探?乳腺MRI与腋窝超声鉴别乳腺癌患者腋窝淋巴结转移的临床价值。方法选择2016年10月～2017年9月在首都医科大学宣武医院接受乳腺癌根治术、改良根治术或保乳根治术的229例患者资料进行回顾性分析。患者术前均接受乳腺MRI和腋窝超声检查，接受根治术治疗及腋窝淋巴结清扫术，术后常规行淋巴结病理检查，观察乳腺MRI和腋窝超声结果与术后病理结果的相关性。结果229例患者中，腋窝淋巴结转移102例，未见转移127例。MRI诊断腋窝淋巴转移108例，其中91例与病例符合，17例误诊，11例漏诊。腋窝超声诊断腋窝淋巴转移98例，与病理诊断符合80例，18例误诊，22例漏诊。MRI判定腋窝淋巴结转移的敏感度高于腋窝超声，差异有统计学意义（P<0.05）；两者判定腋窝淋巴结转移的特异性和准确性差异无统计学意义（P>0.05）。MRI阳性同时腋窝超声阳性判定腋窝淋巴结转移的特异性高于MRI、腋窝超声、MRI阳性或腋窝超声阳性（P<0.05）；MRI阳性或腋窝超声阳性判定腋窝淋巴结转移的敏感度高于MRI、腋窝超声、MRI阳性同时腋窝超声阳性（P<0.05）。结论乳腺MRI和腋窝超声均是检测乳腺癌淋巴结转移的重要手段，二者均阳性作为诊断标准有助于腋窝淋巴结转移确诊，二者之一阳性作为诊断标准有助于腋窝淋巴结转移排除，临床可根据实际情况灵活运用。[关键词]乳腺癌；腋窝淋巴结转移；核磁共振；彩色超声多普勒[]R73[文献标识码]A[]1673-7210（2017）12（b）-0168-04[Abstract]ObjectiveTostudytheclinicalvalueofbreastMRIandaxillaryultrasonographyinthedifferentialdiagnosisofaxillarylymphnodemetastasisinbreastcancerpatients.MethodsThedataof229patientswithbreastcancerunderwentradicalmastectomy，modifiedradicalmastectomyorradicalmastectomyinXuanwuHospitalfromOctober2016toSeptember2017wereretrospectivelyanalyzed.AllpatientsunderwentpreoperativeMRIandaxillaryultrasoundexamination，underwentradicalmastectomyandaxillarylymphnodedissection，andunderwentroutinepathologicalexaminationoflymphnodes.ThecorrelationbetweenMRIandaxillaryultrasoundfindingsandpostoperativepathologicalfindingswereobserved.ResultsAxillarylymphnodemetastasiswasdetectedin102of229patients，andnometastasiswasdetectedin127patients.108casesofaxillarylymphnodemetastasisweredetectedbyMRI，ofwhich91caseswereconsistentwiththecases，17casesweremisdiagnosed，and11casesweremissed.Axillarylymphnodemetastasiswasdetectedin98casesbyultrasound，80caseswereconsistentwithpathologicaldiagnosis，18casesweremisdiagnosed，and22casesweremisseddiagnosis.ThesensitiveofMRIindiagnosisofaxillarylymphnodemetastasiswashigherthanthatofaxillaryultrasound，withstatisticallysignificantdifference（P<0.05）.TherewassignificantdifferenceinspecificityandaccuracyofdiagnosisbetweenMRIandaxillaryultrasound（P>0.05）.ThespecificityofMRIpositiveandaxillaryultrasoundpositiveindiagnosisofaxillarylymphnodemetastasiswashigherthanthatofMRI，axillaryultrasoundandMRIpositiveoraxillaryultrasoundpositive（P<0.05）.ThesensitivityofMRIpositiveoraxillaryultrasoundpositivewashigherthanthatofMRI，axillaryultrasound，MRIpositiveandaxillaryultrasoundpositive（P<0.05）.ConclusionThebreastMRIandaxillaryultrasonographyareimportantmeansofdetectinglymphnodemetastasisinbreastcancer，bothpositiveishelpfulforthediagnosisofaxillarylymphnodemetastasis，onepositiveinthetwoindicatorishelpfulforthediagnosisofaxillarylymphnodemetastasis，clinicalcanflexiblyaccordingtotheactualsituation.[Keywords]Breastcancer；Axillarylymphnodemetastasis；Magneticresonanceimaging；Colordopplerultrasound乳腺癌居女性恶性肿瘤发病率第一位，腋窝淋巴结是乳腺癌常见的转移部位。...