The New Strategy Of Noninvasive Axillary Lymph Node Staging In Breast Cancer? The Initial Clinical Research About The Axillary Lymph Node Staging In Breast Cancer Under By Ultrasound Examination

Object To evaluate the effectiveness of ultrasound on determining axillary lymph node stage for breast cancer clinically.Method From February to December 2014 in our breast surgery department, Employ 200 female breast disease patients, middle age 50 years, including 153 breast cancer cases, 44 fibroadenoma cases, 2 cases of mastitis and a case of huge fibroma. The states of axillary lymph node were assessed by doctor whom has more than twenty years experience of ultrasound diagnosis. According to the characteristics of the ultrasound image of lymph node and experience of the ultrasound doctor, the patients were divided into axillary lymph node metastasis group, suspicious group and no metastasis group. Without knowing the diagnosis of patient’s axillary lymph node of benign disease; in breast cancer patients, the axillary lymph node were staged by sentinel lymph node biopsy or axillary lymph node dissection. Comparing the pathological diagnosis with the results of the ultrasound,we analyse the sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, and metastasis burden of axillary lymph node in false negative patients by ultrasound judgement. We also analysed the relationship between the ultrasound characteristics and axillary lymph node metastasis by univariate analysis.Results:The metastasis rate of axillary lymph node metastasis group, suspicious group and no metastasis group judged by ultrasound are 84.51%, 45.16% and 7.14% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of screening for axillary lymph node metastasis by ultrasound are 89.6%, 89.1%, 84.5%, and 92.7% respectively in metastasis group and no metastasis group. By finishing the consistency analysis between pathological diagnosis and B ultrasound, the Kappa value was 0.779. The false negative rate only 7.1%(7/98 cases) that in no metastasis group judged by ultrasound, and the patient’s axillary lymph node metastasis burden were very low, just only 1 lymph node positive. The univariate analysis shows that the patients with longitudinal diameter of lymph nodes ≥ 1cm have a higher risk for metastasis than the < 1cm(44.2%/14.3%,p < 0.001); Lymph node aspect ratio ≤ 1.5, the lymph node metastasis rate is significant higher than aspect ratio > 1.5, p < 0.001; cortical thickness≥3mm and lymph node appearing blood flow signal of the central or mixed type are also high metastasis risk factor, the lymph node metastasis rate were 67.5%, 75%/79%,compared with the lymph gland appears peripheral or no blood flow phenomenon,statistics has significant differences(p<0.001).Conclusion: Ultrasound is a valuable method for identifying metastasis of axillary lymph node in breast cancer; It has lower false negative rate, and the false negative patients just have smaller axillary lymph node metastasis burden;The longitudinal diameter of lymph nodes more than 1cm、lymph node aspect ratio ≤ 1.5、lymph node of cortical thickness ≥ 3mm and blood flow signal of the central or mixed type have higher relationship with axillary lymph node metastasis. Ultrasound may be Partly Replace method for sentinel lymph nodes biopsy for axillary lymph node staging in early breast cancer.