| Objective:(1)To compare the diagnostic value of preoperative 18F-FDG PET/CT examination,ultrasound examination and the combination of the two examinations for axillary lymph node metastasis in breast cancer patients.(2)To analyze the patient’s clinical features,pathological data and imaging results to establish the relevant risk factors for axillary lymph node metastasis.And to evaluate the diagnostic value of 18F-FDG PET/CT examination,ultrasound examination and the combination of the two examinations in the diagnosis of axillary lymph node metastasis under the condition of independent influencing factors.Methods:A continuous collection of female breast cancer patients diagnosed and treated in the Department of Breast Surgery of China-Japan Union Hospital from September2018 to August 2020.All patients were subjected to thorough history taking,complete physical examination,and relevant blood investigations.Clinical,pathological,18F-FDGPET/CT and ultrasound data of the patients were collected and the above results were summarized.Taking pathological results as the reference standard,analyze whether the results of imaging examination report and pathological results are consistent.SPSS 21.0 software was used for statistical analysis to assess the accuracy of the diagnostic method using receiver operating characteristic(ROC)curve and area under the curve(AUC),and multivariate Logistic regression analysis was used to determine the independent influencing factors.When P<0.05,there was statistical significance.Results:(1)The study finally enrolled 345 female breast cancer patients with an age range of 28-83 years,with an average age of 51 years and a median age of 51 years.237 patients underwent axillary lymph node dissection and 108 patients underwent sentinel lymph node biopsy.Among them,4 of them were pathologically diagnosed as positive for the sentinel lymph node during the operation,and then received axillary lymph node dissection.(2)Pathological diagnosis results:Among the primary tumors,34 cases(9.86%)were diagnosed as carcinoma in situ,287 cases(83.19%)of non-special type invasive carcinoma,and 24 cases(6.95%)of special type invasive carcinoma.There were 223cases(64.64%)without axillary lymph node metastasis,and 122 cases(35.36%)with axillary lymph node metastasis.Among 108 people who underwent sentinel lymph node biopsy,497 sentinel lymph nodes were detected,with an average of 4.6 sentinel lymph nodes detected per person.(3)The sensitivity of 18F-FDG PET/CT in the diagnosis of axillary lymph node metastasis was 73.77%,specificity was 95.07%,accuracy was 87.54%,positive predictive value was 89.11%,negative predictive value was 86.89%,Youden index was 0.69,positive The likelihood ratio is 14.96,and the negative likelihood ratio is0.28.The areas under the curve were 0.844.(4)The sensitivity of ultrasonography to diagnose axillary lymph node metastasis was 83.61%,the specificity was 84.30%,the accuracy was 84.06%,the positive predictive value was 74.5%,and the negative predictive value was 90.38%.The Youden index is 0.68,the positive likelihood ratio is 5.33,and the negative likelihood ratio is 0.19.The areas under the curve were 0.840.(5)The sensitivity of the two combined diagnosis of axillary lymph node metastasis was 88.52%,the specificity was 83.86%,the accuracy was 85.51%,the positive predictive value was 75.00%,the negative predictive value was 93.03%,the Youden index was 0.72,and the positive likelihood ratio was 5.48,The negative likelihood ratio is 0.14.The combined area under the ROC curve is 0.862.(6)The patients were divided into two groups according to the surgical methods received,namely sentinel lymph node biopsy group(SLNB group)and axillary lymph node dissection group(ALND group).In the SLNB group,18F-FDG PET/CT examination and ultrasound examination and the combination of the two had high specificity and negative predictive value,and the difference from pathological diagnosis was not statistically significant(P>0.05).In the ALND group,18F-FDG PET/CT examination is superior to ultrasound examination and the combination of the two in terms of specificity,accuracy,false positive rate,positive predictive value,and the sensitivity,false negative rate and negative prediction of the combination of the two The value further improved,and the difference with pathological diagnosis was statistically significant(P<0.05).(7)Univariate analysis showed that menstrual status,age,primary tumor size,Ki-67 status,and axillary lymph node metastasis were statistically significant(all P<0.05).Binary Logistic regression analysis showed that menopause,primary tumor size>2cm,Ki-67>20%have obvious correlation with axillary lymph node metastasis,which are independent influencing factors.(8)In postmenopausal patients,there was no statistically significant difference between ultrasound examination alone and the combined examination of the two and pathological diagnosis(P>0.05).In premenopausal patients,there was no significant difference between 18F-FDG PET/CT examination and ultrasound examination alone and pathological diagnosis(P>0.05).(9)In patients with primary tumors>2cm in diameter,there was no significant difference between 18F-FDG PET/CT and pathological diagnosis(P>0.05).In patients with the primary tumor diameter≤2cm,there was no statistically significant difference between ultrasound examination alone and the combination of the two and pathological diagnosis(P>0.05).(10)In Ki-67>20%patients,there was no significant difference between18F-FDG PET/CT examination and pathological diagnosis(P>0.05).Among the patients with Ki-67≤20%,there was no statistically significant difference between ultrasound examination alone and the combination of the two and pathological diagnosis(P>0.05).Conclusions:(1)The value of 18F-FDG PET/CT in the diagnosis of axillary lymph node metastasis is slightly higher than that of ultrasound.After the two examinations are combined,the detection of metastatic lymph nodes,the elimination of normal lymph nodes,and the overall accuracy have been improved.(2)In the axillary lymph node dissection group,the diagnostic value of 18F-FDG PET/CT in judging the nature of axillary lymph nodes is higher than that of ultrasound and the combination of the two,but neither can fully accurately determine whether axillary lymph nodes have metastasis.(3)In the sentinel lymph node biopsy group,18F-FDG PET/CT examination and ultrasound examination and the combination of the two have a greater probability of excluding sentinel lymph node metastasis,which is of great reference value for preoperative assessment of axillary lymph node status.(4)Menopausal status,primary tumor diameter>2cm and Ki-67>20%are independent influencing factors of breast cancer axillary lymph node metastasis.(5)In menopausal patients,ultrasound examination alone and the combined examination of the two have a high reference value for judging axillary lymph node metastasis.In premenopausal patients,18F-FDG PET/CT examination alone and ultrasound examination alone have a high reference value for judging axillary lymph node metastasis.(6)In patients with primary tumors greater than 2cm in diameter,18F-FDG PET/CT examination alone has a high reference value for judging axillary lymph node metastasis.In patients with the primary tumor diameter≤2cm,ultrasound alone and the combination of the two have a high reference value for judging axillary lymph node metastasis.(7)In patients with Ki-67>20%,18F-FDG PET/CT examination alone has a high reference value for judging axillary lymph node metastasis.In patients with Ki-67≤20%,ultrasound alone and the combination of the two have a high reference value for judging axillary lymph node metastasis. |
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