目的：总结探讨US预测转移性腋窝淋巴结（Axillary Lymphnode， ALN）的合理诊断标准，旨在提高US诊断转移性ALN的准确能力，为临床医师实施ALN手术及术后对乳腺癌患者采取个体化治疗措施提供可靠的依据。方法经术后病理证实的126例乳腺癌患者术前1 d均用彩色多普勒诊断仪高频线阵探头探查乳腺肿块及显像ALN的大小、形态、内部结构等声像表现；然后计算整理出显像ALN的短径值、短长径比、最大皮质厚度、最大皮质厚度/径线比4组研究指标数据。结果126例乳腺癌患者中病理检出ALN共计2474枚：转移性ALN共计627枚，人均检出4．98枚，占比仅为25．34％。US共探出并定位记号处ALN 234枚；经术后病理证实为转移性ALN 180枚，占比76．92％，人均探出1．86枚。短径值≥7 mm、短长径比≥0．5、皮质最大厚度≥3 mm、皮质最大厚度/径线比≥0．4作为US预测转移性ALN的阈值诊断标准时，与病理对比吻合度相对较强。ROC曲线法计算上述4组数据曲线下的面积分别为：0．811、0．711、0．868、0．899。结论 ALN的转移过程是个连续动态的过程，多个声像学征象联合可提高US对转移ALN的检出能力；通过上述阈值标准，可进一步提高US对转移性ALN的检出率及准确能力；转移性ALN的内部结构是其形态、大小变化的基础，前者比后两者对US诊断转移性ALN的相对价值意义大，通过综合分析ALN内部结构变化、形态改变、大小变化可进一步提高US诊断转移性ALN的准确能力。%Objective To discuss and summarize the reasonable diagnosis standard of axillary lymph node metastasis by ultrasound. To improve the ability of ultrasonographic in distiguishing metastatis lymphnodes and to pro-vide the important basis for the individual treatment of breast cancer patients after surgery operation program. Methods All the detailed hospital data of 126 cases with the metastic lymph nodes of breast cancer were collected, who under-went the detection of breast tumor and the size, the shape, the internal structure, the flow distribution of axillary lymph node were collected. Results Of 126 patients 2 474 lymph nodes were detected by pathology which contained 627 metastatic lymph nodes, 234 lymph nodes were detected which contained 180 metastatic lymph nodes and 54 non metastatic lymph nodes. The short diameter≥7 mm, the short-to-long ratio≥0.5, the maximum thickness of the cortex≥3 mm, the maximum thickness of the cortex-to-the diameter ratio≥0.4 had the better consistency with postoperative pathological findings. Conclusion Metastatic axillary lymph node in grey scale imaging and color dopper imaging performance have dynamic process of continuous, a plurality of sonographic features combination can improve the de-tection ability of ultrasonography in axillary lymph node. Through the standard above it can further improve the ability to predict the axillary lymph node metastasis ultrasonography. The change of internal structures of the axillary lymph node was the basic change of morphological and size changes. The forth was more valuable than the latter two for US in diagnosing of axillary lymph nodes metastasis of infiltrative breast cancer, through the comprehensive analysis of the ALN internal structure changes, morphological changes, size changes can further improve the accuracy of US in diag-nosising of metastatic ability of ALN.
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