| Part I The value of ultrasound in the diagnosis of breast ductal carcinoma in situ with microinvasive axillary lymph node metastasis Objective:To explore the value of ultrasound diagnosis of axillary lymph node metastasis(ALNM)in patients with ductal carcinoma in situ with microinvasion(DCISM).Methods:Clinical information of 93 patients with DCISM who were confirmed by surgery and pathology from Shanxi Provincial Tumor Hospital from January 2015 to December2020 were collected.Routine breast and ALN ultrasound examinations were performed before surgery.The postoperative pathological results were used as the gold standard.ALN was divided into the metastasis groups and the non-metastatic group,the ultrasound imaging characteristics of the two groups’ s lymph nodes were compared and analyzed,and the receiver operating characteristic(ROC)curve was used for analysis and evaluation.Results:(1)Of the 93 DCISM patients in this group,9 of them had ALNM,with a metastasis rate of 9.68%;a total of 53 cases of lymph were detected by ultrasound before surgery,and the ALN rate of ultrasound detection was 57.0%.The sensitivity,specificity,accuracy,misdiagnosis rate and missed diagnosis rate of ALNM in the diagnosis of DCISM by ultrasound were 66.7%,90.9%,86.8%,9.1%,and 33.3%,respectively.(2)In this study,the mean of the width and taller-than-wide shape of the lymph node in the metastasis group were 1.08(0.53～2.15)and 1.53(1.29～1.64),respectively,compared with 0.59(0.38～0.88)and 2.01(1.17～3.47)in the non-metastasis group.The difference between the two groups was statistically significant(all P<0.05).There were also statistically significant between the axillary lymph node metastasis group and the non-metastasis group in whether the cortex was thickened,whether the lymphatic hilum disappeared,and the abundance of blood flow signals were also statistically significant(P<0.05).(3)ROC curve analysis shows that the sensitivity of taking lymph node width ≥0.76 cm to diagnose ALNM is 88.9%,and the specificity is 95.5%;the sensitivity of taking taller-than-wide shape ≤ 1.65 to diagnose ALNM is 100%,and the specificity is61.5%.Conclusion:The incident of ALNM is low in DCISM patients.There are significant significally differences between the metastatic and non-metastatic lymph nodes in terms of cortical thickness,blood flow distribution,lymphatic hilum structure disappearance or not,width and taller-than-wide shape.And taking the taller-than-wide shape≤1.65 and(or)width≥0.76 cm can improve the diagnosis rate of ALNM by ultrasound.Part II Risk factors for Axillary Lymph Node Metastases in Breast Ductal Carcinoma in situ with MicroinvasiveObjective:To explore the risk factors of ALNM in DCISM patients.Methods:Clinical information of 93 patients with DCISM who were confirmed by surgery and pathology from Shanxi Provincial Tumor Hospital from January 2015 to December2020 were collected.First,the chi-square test was used to choose the significant indicators statistically,and then the above indicators were included in the Logistic regression analysis to evaluate the risk factors of ALNM in patients with DCISM.Results:Univariate analysis showed that there were statistically significant differences in ER positive expression(P=0.022),infiltration foci ≥ 2(P=0.026),and vascular tumor thrombus(P<0.001)between the two groups;multivariate Logistic regression analysis showed,ER positive expression(P=0.021)and infiltration foci ≥ 2(P=0.012)were independent risk factors of axillary lymph node metastasis in DCISM patients.Conclusion:The incidence of ALNM is low in DCISM patients.The multifocal and positive ER status may predict axillary metastases.Such patients should undergo more active ALN management. |
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