【摘要】 目的：探讨超声联合MRI对乳腺癌腋窝淋巴结转移的预测价值。方法：回顾性收集140例经病理证实的乳腺癌患者，所有患者术前均做过常规超声、超声造影、剪切波弹性成像、动态对比增强MRI（DCE-MRI）及DWI检查。将140例乳腺癌患者根据术后病理分为两组，有腋窝淋巴结转移组54例及无腋窝淋巴结转移组86例。回顾性分析两组乳腺癌原发肿块在超声及MRI的图像差异，评估各参数与腋窝淋巴结转移的相关性，进而评估超声联合MRI预测乳腺癌腋窝淋巴结转移的诊断效能。结果：单因素分析结果显示：两组在肿块的长径、形态、边缘、纵横比、有无毛刺征、分叶状态、Adler血流分级、剪切波速度平均值(SWV_mean)、CEUS增强强度、CEUS增强方式、CEUS有无穿支血管征、DWI的ADC值差异有统计学意义（P<0.05）；多因素分析结果显示：肿块的长径、CEUS增强强度、CEUS增强模式、SWV_mean及ADC值是乳腺癌腋窝淋巴结转移的独立危险因素；以此五项参数建立Logistic回归方程式为：Logistic（P）=-6.664+0.080×肿块长径+2.546×CEUS增强强度+2.068×CEUS增强模式+0.887×SWV_mean-2.811×ADC值。五者联合预测乳腺癌腋窝淋巴结转移的曲线下面积（0.924）高于肿块长径（0.708）、CEUS增强强度（0.619）、CEUS增强模式（0.672）、SWV_mean（0.791）及ADC值（0.700）。结论：肿块的长径、CEUS增强强度、CEUS增强模式、SWV_mean及ADC值是乳腺癌腋窝淋巴结转移的独立危险因素，五者联合诊断具有较高的预测效能，超声联合MRI在一定程度上提高了预测乳腺癌腋窝淋巴结转移的诊断效能。更多还原

【Abstract】 Objective: To explore the value of ultrasound combined with MRI in predicting axillary lymph node metastasis in breast cancer. Methods: This study retrospectively analyzed 140 pathologically confirmed breast cancer patients, all of whom underwent preoperative conventional ultrasound, contrast-enhanced ultrasound（CEUS）, SWE, dynamic contrast-enhanced MRI（DCE-MRI）, and DWI. Based on postoperative pathology, the patients were divided into two groups: 54 cases with axillary lymph node metastasis and 86 cases without metastasis. The imaging differences in primary breast lesions between the two groups were compared using ultrasound and MRI. The correlation between various imaging parameters and axillary lymph node metastasis was evaluated, and the diagnostic performance of combining ultrasound and MRI in predicting axillary lymph node metastasis in breast cancer was assessed. Results: The results of single factor analysis showed that: there were significant differences in the length diameter, shape, margin, aspect ratio, presence or absence of spiculation, lobulation, Adler blood flow grading, mean shear wave velocity(SWV_mean), enhancement intensity of CEUS, enhancement mode of CEUS, presence or absence of perforating vessel sign of CEUS, and ADC value of DWI between the two groups（P<0.05）. The results of multivariate analysis showed that the tumor length, intensity of CEUS enhancement, mode of CEUS enhancement, SWV_meanand ADC values were independent risk factors for axillary lymph node metastasis of breast cancer. The Logistic regression equation established with these five parameters is as follows: Logistic（P）=-6.664+0.080×long diameter of the mass+2.546×CEUS enhancement intensity+2.068×CEUS enhancement mode+0.887×SWV_mean-2.811×ADC value. The combination of five parameters, which was higher than the mass length diameter（0.708）, CEUS enhancement intensity（0.619）, CEUS enhancement pattern（0.672）, SWV_mean（0.791）, and ADC value（0.700）. Conclusion: Tumor length, CEUS enhancement intensity, CEUS enhancement mode, SWV_meanand ADC value are independent risk factors for axillary lymph node metastasis of breast cancer. The combined diagnosis of the five has high predictive efficacy. Ultrasound combined with MRI can improve the diagnostic efficacy for predicting axillary lymph node metastasis of breast cancer to a certain extent.更多还原