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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (10) : 743 -748. doi: 10.3877/cma.j.issn.1672-6448.2017.10.006

所属专题： 妇产科超声影像学； 乳腺超声； 文献；

浅表器官超声影像学

超声与正电子发射型计算机断层成像技术在乳腺癌诊断及淋巴结评估中的应用
王红燕1, 靳晓娜1, 姜玉新1,†(), 朱朝晖1, 徐颖1, 朱庆莉1, 戴晴1, 李建初1, 李方1   
  1. 1. 100730　中国医学科学院　北京协和医学院　北京协和医院超声医学科
  • 收稿日期:2017-01-01 出版日期:2017-10-01
  • 通信作者: 姜玉新
  • 基金资助:
    国家自然科学基金(81601517，81371557)

Comparison of ultrasound and position emission tomography / computerized tomography in diagnosis and lymph node staging of breast cancer

Hongyan Wang1, Xiaona Jin1, Yuxin Jiang1,†(), Zhaohui Zhu1, Ying Xu1, Qingli Zhu1, Qing Dai1, Jianchu Li1, Fang Li1   

  1. 1. Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • Received:2017-01-01 Published:2017-10-01
  • Corresponding author: Yuxin Jiang
  • About author:
    Corresponding author: Jiang Yuxin, Email:
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王红燕, 靳晓娜, 姜玉新, 朱朝晖, 徐颖, 朱庆莉, 戴晴, 李建初, 李方. 超声与正电子发射型计算机断层成像技术在乳腺癌诊断及淋巴结评估中的应用[J/OL]. 中华医学超声杂志（电子版）, 2017, 14(10): 743-748.

Hongyan Wang, Xiaona Jin, Yuxin Jiang, Zhaohui Zhu, Ying Xu, Qingli Zhu, Qing Dai, Jianchu Li, Fang Li. Comparison of ultrasound and position emission tomography / computerized tomography in diagnosis and lymph node staging of breast cancer[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(10): 743-748.

目的

比较超声与正电子发射型计算机断层成像（PET/CT）技术在乳腺癌早期诊断中的应用价值。

方法

选取2014年2月至12月在北京协和医院行乳腺病变切除活检术的患者38例，共40个病灶，分别行超声及PET/CT检查，以病理诊断为"金标准"分别统计自动乳腺全容积成像系统（ABVS）及PET/CT的敏感度、特异度、准确性、假阳性、假阴性、阳性及阴性预测值。

结果

超声对乳腺癌诊断的敏感度95.65%、特异度70.59%、准确性85.00%；PET/CT技术对乳腺癌诊断的敏感度86.96%、特异度82.35 %、准确性85.00 %；两者联合应用的诊断敏感度86.96%、特异度94.12%、准确性90.00%。10例乳腺癌淋巴结转移的患者中，PET/CT技术对转移淋巴结诊断的敏感度、特异度及准确性分别为90.0%、92.8%、92.1%，超声对转移淋巴结诊断的敏感度、特异度及准确性分别为70.0%、96.4 %、89.5%。

结论

超声与PET/CT检查对乳腺癌的诊断均为有效的方法。两者联合应用可显著提高诊断的特异度与准确性。PET/CT对淋巴结转移灶敏感度较高，有利于临床分期，对临床治疗方案的选择及患者的预后有重要意义。

关键词: 超声检查, 自动乳腺全容积成像, 乳腺肿瘤
Objective

To compare the application of ultrasound and positron emission tomography/computed tomography (PET/CT) in diagnosis and lymph node staging of breast cancer.

Methods

Using automated breast volume scanner (ABVS) and PET/CT examination of 40 lesions in 38 patients, and for comparison with the pathological findings, the diagnostic accuracy of PET/CT and ABVS in breast cancer was comparatively analyzed.

Results

The sensitivity of ABVS in the diagnosis of breast cancer was 95.65%, the specificity was 70.59%, and the accuracy rate was 85.00%; the sensitivity of PET/CT in the diagnosis of breast cancer was 86.96%, the specificity was 82.35%, and the accuracy rate was 85.00%; the diagnostic sensitivity of their combined application was 86.96%, the specificity was 94.12%, and the accuracy rate was 90.00%. In 10 cases of breast cancer patients with lymph node metastasis, the sensitivity、specificity and accuracy rate of PET/CT in the diagnosis of metastatic lymph nodes were 90.0%, 92.8%, and 92.1% respectively; the sensitivity, specificity and accuracy rate of ultrasound in the diagnosis of metastatic lymph nodes were 70.0%, 96.4% and 89.5%, respectively.

Conclusions

The ABVS and PET/CT are both effective approaches in the diagnosis of breast cancer. Their combined application may significantly improve the specificity and accuracy of diagnosis. For patients with lymph node metastases, the sensitivity of PET/CT for lymph node metastases was high and conducive to clinical staging, which is an important implication in guiding the choice of clinical treatment and prognosis of patients.

Key words: Ultrasonography, Automated breast volume scanner, Breast neoplasms
表1 PET/CT及ABVS对乳腺癌原发灶的诊断价值（%）
检查方法 诊断标准 敏感度 特异度 阳性预测值 阴性预测值 准确性
ABVS BI-RADS>4 95.65 70.59 81.48 92.31 85.00
PET/CT SUV>2.1 86.96 82.35 86.96 82.35 85.00
PET/CT联合ABVS BI-RADS>4同时SUV>2.1 86.96 94.12 95.24 84.21 90.00
图3，4 患者女，63岁，病理为右乳浸润性导管癌（低分化），无淋巴结转移。图3为ABVS右乳外上9~10点见低回声区，大小约2.5 cm，形态不规则，边界不清，回声尚均，超声诊断BI-RADS 5；图4为PET-CT右乳外上象限见一形态不规则且密度欠均匀病灶（箭头所示），大小约2.6 cm，放射性摄取不均匀增高，SUVmax：4.8，病灶内部见放射性减低区
图5 患者女，67岁，病理证实为左乳腺浸润性导管癌。PET-CT示：左乳巨大代谢增高灶，大小，SUV。双侧腋下、纵膈多发肿大淋巴结，代谢明显增高，双侧肋骨、多个脊椎、骨盆多发骨质破坏，代谢增高，均考虑转移灶
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