超声在乳腺神经内分泌癌诊断与术前TNM分期中的应用

摘要

Objective To investigate the value of ultrasonography in diagnosis and preoperative TNM staging for neuroendocrine breast cancer(NEBC).Methods The ultrasonic characteristics of 12 NEBC and 104 invasive ductal carcinoma(IDC) confirmed by pathology,as well as the metastatic lymph nodes were analyzed retrospectively.The TNM-staging for NEBC by preoperative ultrasonography was evaluated according to pathology.And the relation between lesions size and Ki-67 was then analyzad.Results NEBC lesions mainly showed solid and heterogeneous hypoechoic(66.67％),irregular shape(66.67％),clear border (58.33 ％),posterior enhancement(58.33 ％) and internal blood flow(grade 0-Ⅰ) (66.67 ％).The detection rate of unclear border,irregular edge,hyperechoic halos and uneven internal echo was lower than IDC(P ＜ 0.05).Meanwhile,NEBC had a lower detection rate of calcification and internal blood flow(grade Ⅱ-Ⅲ)than IDC (P ＞0.05).And the detection rate of more round or oval lesions were higher in NEBC than that in IDC (P =0.001).According to pathology,the ultrasonic coincidence rate for T staging of NEBC and pathology was 75％,and for T1-staging was 100％,for T2-staging was 80％.The sensitivity,specificity,positive predictive value and negative predictive value of ultrasonic diagnosis on lymph node metastases was 66.67％,88.89％,66.67％ and 88.89％,respectively.There was a positive correlation between focal maximum diameter with Ki-67 (r=0.026,P=0.004).Conclusions It shows certain value of ultrasonography in diagnosis and preoperative TNM staging for NEBC.%目的 探讨超声在乳腺神经内分泌癌(neuroendocrine breast cancer,NEBC)的诊断与术前TNM分期中的应用价值.方法 将病理证实的12例NEBC与104例浸润性导管癌(invasive ductal carcinoma,I DC)及其淋巴结转移的术前声像图进行回顾性对比分析,将超声对NEBC术前TNM分期与术后病理进行对照,并分析NEBC病灶大小与Ki-67的线性关系.结果 NEBC的声像图特征主要表现为不均质实性低回声病灶(66.67％)、形态不规则(66.67％)、边界清晰(58.33％)、后方回声增强(58.33％),肿块内部测及0～Ⅰ级血流信号(66.67％);边界不清、边缘不规则、周边高回声晕及病灶内部回声不均的检出率均低于IDC(P＜0.0)5);病灶呈近圆形或椭圆形的检出率高于IDC(P =0.001);病灶内钙化灶及Ⅱ-Ⅲ级血流信号的检出率低于IDC(P＞0.05).超声对NEBC的T分期与病理T分期总符合率为75.0％,其中对T1诊断符合率为100％,对T2诊断符合率为80％.超声提示淋巴结转移的灵敏性为66.67％,特异性为88.89％,阳性预测值66.67％,阴性预测值88.89％.NEBC病灶最大径与Ki-67呈正相关(r=0.026,P=0.004).结论 超声在NEBC的诊断与术前TNM分期评估中具有一定的应用价值.