ROC曲线评估超声造影对三阴性乳腺癌腋窝淋巴结的诊断价值

目的:分析对比增强超声造影对三阴性乳腺癌TAC化疗前腋窝淋巴结状态的评估价值，并采用ROC曲线评估其诊断腋窝淋巴结转移的价值。方法:选择2016年3月-2018年5月在本院诊治的86例三阴性乳腺癌患者作为研究对象，所有患者在进行化疗前均进行对比增强超声造影检查，以术后病理诊断结果为金标准，分析对比增强超声造影评估腋窝淋巴结转移的敏感性和特异性，比较腋窝淋巴结转移和未转移患者的对比增强超声造影检查参数，以淋巴结实质内高灌注区和低灌注区的差异度（SImax-SImin）做ROC曲线，分析对比增强超声造影对患者腋窝淋巴结转移的诊断价值。结果:病理检查结果腋窝淋巴结转移41例；对比增强超声造影检查结果34例腋窝淋巴结转移，52例未见淋巴结转移，其中假阳性2例，假阴性9例，其评估乳腺癌腋窝淋巴结转移的敏感性为78.05％，特异性为95.56％，阳性预测值为94.12％，阴性预测值为82.69％；腋窝淋巴结转移组SImax-SImin显著大于淋巴结未转移组，当SImax-SImin大于临界值20.96时，对比增强超声造影鉴别乳腺癌腋窝淋巴结转移的敏感性为85.29％，特异性为80.77％。结论:对比增强超声造影在三阴性乳腺癌TAC化疗前腋窝淋巴结状态评估和淋巴结转移诊断中具有较高的敏感性和特异性，可用于临床指导三阴性乳腺癌治疗方式及腋窝手术方式。

ROC curve evaluation of contrast-enhanced ultrasound in the diagnosis of axillary lymph nodes in trinegative breast cancer

Objective:To analyze the value of contrast-enhanced ultrasound in assessing axillary lymph node status of triple negative breast cancer before TAC chemotherapy,and to evaluate the value of ROC curve in diagnosing axillary lymph node metastasis.Methods:From March 2016 to May 2018,86 patients with triple negative breast cancer diagnosed and treated in our hospital were selected as the subjects.All patients underwent contrast-enhanced ultrasound before chemotherapy.Postoperative pathological diagnosis result was used as the gold standard.The sensitivity and specificity of contrast-enhanced ultrasound in evaluating axillary lymph node metastasis were analyzed and compared.Illary lymph node metastasis and non-metastasis patients were compared.The ROC curve was obtained from the difference between high perfusion area and low perfusion area in lymph node (SImax-SImin).Diagnostic value of contrast-enhanced contrast-enhanced ultrasound in axillary lymph node metastasis was analyzed.Results:Pathological examination showed axillary lymph node metastasis in 41 cases.Contrast-enhanced ultrasound showed that 34 cases had axillary lymph node metastasis,and 52 cases had no lymph node metastasis,including 2 cases of false positive and 9 cases of false negative.The sensitivity to evaluate axillary lymph node metastasis in breast cancer was 78.05%,and the specificity was 95.56%,the positive predictive value was 94.12%,and the negative predictive value was 82.69%.The SImax-SImin of axillary lymph node metastasis group was significantly higher than that of non-metastasis group.When the SImax-SImin was greater than the critical value of 20.96,the sensitivity and specificity of contrast-enhanced ultrasound in differentiating axillary lymph node metastasis of breast cancer were 85.29% and 80.77% respectively.Conclusion:Contrast enhanced ultrasound has high sensitivity and specificity in axillary lymph node status assessment and lymph node metastasis diagnosis of triple negative breast cancer before TAC chemotherapy.It can be used to guide the treatment of three negative breast cancer and axillary operation.