Diagnostic Value of Enhanced CT Combined with Serum Hmam Level in Detection of Axillary Lymph Node Metastasis of Breast Cancer
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摘要:
目的：探讨增强CT联合血清人乳腺珠蛋白（hMAM）水平检测对乳腺癌腋窝淋巴结转移的诊断价值。方法：选取2017年6月至2020年6月之间我院就诊并行手术治疗的乳腺癌患者100例，所有患者术前均行增强CT，并检测血清hMAM水平，以术后病理结果为标准，比较增强CT、血清hMAM水平单独检查及联合检查对腋窝淋巴结转移的检出率，分析其与病理结果的一致性，进一步分析增强CT联合血清hMAM水平对乳腺癌腋窝淋巴结转移的诊断价值。结果：血清hMAM和病理结果共同诊断为腋窝淋巴结转移阳性的患者51例（51％），血清hMAM和病理结果共同诊断为腋窝淋巴结转移阴性的患者12例（12％），一致率81.5％，Kappa检验一致性良好；增强CT和病理结果共同诊断为腋窝淋巴结转移阳性的患者55例（55％），增强CT和病理结果共同诊断为腋窝淋巴结转移阴性的患者13例（13％），一致率82.3％，Kappa检验一致性良好；增强CT联合血清hMAM检查和病理结果共同诊断为腋窝淋巴结转移阳性的患者61例（61％），增强CT联合血清hMAM检查和病理结果共同诊断为腋窝淋巴结转移阴性的患者16例（16％），一致率90.4％，Kappa检验一致性良好；增强CT和血清hMAM对淋巴结转移检出的灵敏度分别78.0％ 和76.5％，特异度分别69.5％ 和70.3％，差异不具有显著性，增强CT联合血清hMAM对淋巴结转移检出的灵敏度、特异度明显高于两者单独检查，差异具有统计学意义。结论：增强CT联合血清hMAM水平对乳腺癌腋窝淋巴结转移具有较高的诊断价值，和病理结果比较一致性高，乳腺癌术前综合检查、全面分析，有利于疾病的诊断，对于手术方式的选择提供依据。
Abstract:Objective: To investigate the diagnostic value of enhanced CT combined with serum human mammaryglobin (hMAM) level in detection of axillary lymph node metastasis of breast cancer. Methods: 100 patients with breast cancer treated in our hospital from June 2017 to June 2020 were selected. All patients underwent enhanced CT before operation, and the serum hMAM level was detected. We further analyzed the diagnostic value of enhanced CT combined with serum hMAM level in axillary lymph node metastasis of breast cancer by comparing the consistency between the results of the detection rate of axillary lymph node metastasis obtained respectively by enhanced CT, serum hMAM level, combined examination and the postoperative pathological results which was taken as the standard. Results: 51 patients (51%) were diagnosed as positive axillary lymph node metastasis by serum hMAM and pathological results while 12 patients (12%) with negative axillary lymph node metastasis were diagnosed by both serum hMAM and pathological results, with the consistency rate of 81.5%. Kappa test showed great consistency, 55 cases (55%) were diagnosed as positive axillary lymph node metastasis by enhanced CT and pathological results while 13 cases (13%) with negative axillary lymph node metastasis were diagnosed by enhanced CT and pathology, with the consistency rate of 82.3%. Kappa test showed great consistency, There were 61 cases (61%) with positive axillary lymph node metastasis diagnosed by enhanced CT combined with serum hMAM examination and pathological results while 16 cases (16%) with negative axillary lymph node metastasis diagnosed by enhanced CT combined with serum hMAM examination and pathological results, with the consistency rate of 90.4%. Kappa test showed great consistency, The sensitivity of enhanced CT and serum hMAM were respectively 78.0% and 76.5% while the specificity were respectively 69.5% and 70.3%, which showed no significant difference. The sensitivity and specificity of enhanced CT combined with serum hMAM in detecting lymph node metastasis were significantly higher than those of the two alone. Conclusion: The method of enhanced CT combined with serum hMAM level hold high diagnostic value for axillary lymph node metastasis of breast cancer, and show high consistency with the pathological results. Preoperative comprehensive examination and comprehensive analysis of breast cancer are conducive to the diagnosis of the disease and can provide basis for the selection of surgical methods.
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Keywords:
- enhanced CT /
- serum hMAM /
- breast cancer /
- axillary lymph node metastasis
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图 2 增强CT和血清hMAM对淋巴结转移灵敏度及特异度ROC曲线图
Figure 2. ROC curve of sensitivity and speci-ficity of enhanced CT and serum hMAM for lymph node metastasis
表 1 血清hMAM和病理结果比较
Table 1 Comparison between serum hMAM and pathological results
病理 血清 hMAM 一致率/％ K P 阳性/例 阴性/例 腋窝淋巴结阳性 51 27 81.5 0.753 0.000 腋窝淋巴结阴性 10 12 
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表 2 血清hMAM和不同大小的阳性腋窝淋巴结比较
Table 2 Comparison between serum hMAM and positive axillary lymph nodes of different sizes
腋窝淋巴结大小/cm hMAM/（ng/mL） F P <1 8.9±4.12 1.590 0.043 1～2 9.3±4.23 >2 9.8±4.18
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2 血清hMAM和不同大小的阳性腋窝淋巴结比较
腋窝淋巴结大小/cm hMAM/（ng/mL） F P <1 8.9±4.12 1.590 0.043 1～2 9.3±4.23 >2 9.8±4.18
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表 3 增强CT结果和病理结果比较
Table 3 Comparison between enhanced CT results and pathological results
病理 增强CT 一致率/％ K P 阳性/例 阴性/例 腋窝淋巴结阳性 55 23 82.3 0.755 0.000 腋窝淋巴结阴性 9 13
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表 4 增强CT联合血清hMAM结果和病理结果比较
Table 4 Comparison between enhanced CT combined with serum hMAM results and pathological results
病理 增强 CT 联合血清 hMAM 一致率/％ K P 阳性/例 阴性/例 腋窝淋巴结阳性 61 17 90.4 0.757 0.000 腋窝淋巴结阴性 6 16
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4 增强CT联合血清hMAM结果和病理结果比较
病理 增强 CT 联合血清 hMAM 一致率/％ K P 阳性/例 阴性/例 腋窝淋巴结阳性 61 17 90.4 0.757 0.000 腋窝淋巴结阴性 6 16
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5 增强CT和血清hMAM对淋巴结转移灵敏度及特异度对比（
$\bar x \pm s $ ）组别 增强 CT 血清 hMAM 增强 CT 联合血清 hMAM t P 灵敏度/％ 78.0 76.5 88.7 6.32 0.061 特异度/％ 69.5 70.3 83.5
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表 5 增强CT和血清hMAM对淋巴结转移灵敏度及特异度对比（
$\bar x \pm s $ ）Table 5 Comparison of sensitivity and specificity between enhanced CT and serum hMAM for lymph node metastasis (
$\bar x \pm s $ )组别 增强 CT 血清 hMAM 增强 CT 联合血清 hMAM t P 灵敏度/％ 78.0 76.5 88.7 6.32 0.061 特异度/％ 69.5 70.3 83.5
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