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Received:December 16, 2025 Published Online:May 01, 2026
Received:December 16, 2025 Published Online:May 01, 2026
中文摘要: 目的 分析超声与超声造影联合检查对乳腺癌腋窝淋巴结转移的诊断价值，明确相关独立危险因素。方法 回顾性选取2022年1月至2024年12月北京中医医院内蒙古医院收治的102例乳腺癌患者。所有患者均在术前1周内依次完成超声、超声造影、磁共振成像（MRI)、钼靶检查，非同期一次性操作，按临床诊疗规范分时段完成。患者均经病理组织学检查确诊。以术后淋巴结病理结果为金标准，采用 Kappa 值评估诊断的一致性，受试者工作特征（ROC）曲线评估各项检查的诊断价值，多因素 logistic 回归筛选独立危险因素（采用逐步回归法控制变量数量）。结果 102例患者中，病理确诊淋巴结转移37例（36.27%）。超声与超声造影联合检查的Kappa值为0.936，准确度为0.971，特异度为0.985，灵敏度为0.946。ROC曲线显示，联合检查的曲线下面积为 0.965（95%CI ：0.919~1.000），显著高于单一超声（AUC=0.811，95%CI ：0.715~0.907）、超声造影（AUC=0.882，95%CI ：0.802~0.963)、MRI（AUC=0.853，95%CI ：0.766~0.941)、钼靶检查（AUC=0.803，95%CI ：0.707~0.900）（P<0.05）。多因素logistic回归分析显示，超声与超声造影影像中肿瘤直径≥2 cm、淋巴结最大皮质厚度≥3 mm、增强模式不规则均为乳腺癌腋窝淋巴结转移的独立危险因素（P<0.05）。结论 超声与超声造影联合检查在乳腺癌腋窝淋巴结转移诊断中具有较高的应用价值，诊断效能优于单一超声、超声造影及传统MRI、钼靶检查，可为临床诊疗提供可靠依据。
Abstract:Objective To analyze the diagnostic value of ultrasound（US）combined with contrast-enhanced ultrasound（CEUS）in axillary lymph node metastasis of breast cancer，and to identify the related independent risk factors.Methods A retrospective selection was made of 102 breast cancer patients admitted to Inner Mongolia Hospital Beijing Hospital of Traditional Chinese Medicine from January 2022 to December 2024. All patients completed US，CEUS，magnetic resonance imaging（MRI），and mammography examinations in sequence within one week before surgery，withnon-simultaneous one -time operations，and the examinations were conducted at different time periods in accordance with clinical diagnosis and treatment norms. Patients were diagnosed by histopathological examination. The postoperative lymph node pathological Results were used as the gold standard，and Kappa value was used to evaluate thediagnostic consistency of each examination. Receiver operating characteristic（ROC）curve was used to evaluate its diagnostic value，and multivariate logistic regression was used to screen independent risk factors（stepwise regression method was used to control the number of variables）. Results Among 102 patients，37 cases（36.27%）were pathologically diagnosed with lymph node metastasis. The Kappa value of US combined with CEUS was 0.936，the accuracy was0.971，the specificity was 0.985，and the sensitivity was 0.946. ROC curve showed that the area under the curve（AUC）of combined examination was 0.965（95%CI ：0.919-1.000），which was significantly higher than that of single US（AUC=0.811，95%CI ：0.715-0.907），CEUS（AUC=0.882，95%CI ：0.802-0.963），MRI（AUC=0.853, 95%CI ：0.766- 0.941），and mammography（AUC=0.803，95%CI ：0.707- 0.900）（P<0.05）. Multivariate logistic regression analysis showed that in US and CEUS imaging，tumor diameter ≥2 cm，maximum cortical thickness of lymph nodes ≥3 mm，and irregular enhancement pattern were independent risk factors for axillary lymph node metastasis of breast cancer（P<0.05）. Conclusion The combined examination of US and CEUS has high application value in the diagnosis of axillary lymph node metastasis of breast cancer，and the diagnostic efficacy is better than single US，CEUS，traditional MRI and mammography，which can provide reliable basis for clinical diagnosis and treatment.
keywords: Ultrasound Contrast-enhanced ultrasound Breast cancer Axillary lymph node metastasis Pathology Tumor diameter Cortical thickness of lymph node
文章编号： 中图分类号：R737.9 文献标志码：A
基金项目:内蒙古自治区自然科学基金青年基金项目（2023QN08044）
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