發(fā)布時間：2018-02-27 02:13

  本文關(guān)鍵詞： 超聲 乳腺癌 淋巴結(jié)　出處：《復(fù)旦大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分術(shù)前專項超聲對于-早期乳腺癌腋下淋巴結(jié)診斷價值初步探討目的：探討術(shù)前專項超聲對于臨床體檢腋窩陰性乳腺癌前哨淋巴轉(zhuǎn)移狀態(tài)的診斷效能,以及前哨淋巴結(jié)活檢聯(lián)合術(shù)前專項超聲對乳腺癌非前哨淋巴結(jié)轉(zhuǎn)移情況的預(yù)測能力。方法：對于乳腺原發(fā)病灶粗針穿刺活檢確診為浸潤性癌的病例,于術(shù)前一名高年制醫(yī)師對其腋下進(jìn)行有針對性的掃查。超聲診斷腋下淋巴結(jié)轉(zhuǎn)移的診斷標(biāo)準(zhǔn)包括回聲低、形態(tài)不規(guī)則或飽滿、邊界不清、淋巴門結(jié)構(gòu)不清、皮質(zhì)不均質(zhì)增厚。所有淋巴結(jié)所有超聲征象均符合良性則診斷為腋下淋巴結(jié)無轉(zhuǎn)移,反之則診斷為腋下淋巴結(jié)有轉(zhuǎn)移。超聲診斷結(jié)果與病理結(jié)果對照,分析術(shù)前專項超聲與前哨淋巴結(jié)轉(zhuǎn)移情況的符合率,以及術(shù)前專項超聲聯(lián)合前哨淋巴結(jié)活檢與非前哨淋巴結(jié)轉(zhuǎn)移狀態(tài)的符合率。結(jié)果：入組共96例病例,病理證實(shí)前哨淋巴結(jié)有轉(zhuǎn)移17例,前哨淋巴結(jié)轉(zhuǎn)移發(fā)生率17.7%。術(shù)前專項超聲診斷為腋下淋巴結(jié)有轉(zhuǎn)移17例,其中真陽性8例。術(shù)前專項超聲診斷前哨淋巴結(jié)轉(zhuǎn)移的靈敏度47.1%,特異度88.6%,陽性預(yù)測值47.1%,陰性預(yù)測值88.6%,準(zhǔn)確度81.3%。前哨淋巴結(jié)陽性的病例中,超聲診斷為腋下淋巴結(jié)有轉(zhuǎn)移8例,其中非前哨淋巴結(jié)有轉(zhuǎn)移5例,無轉(zhuǎn)移3例；超聲診斷腋下淋巴結(jié)無轉(zhuǎn)移病例9例,其中非前哨淋巴結(jié)有轉(zhuǎn)移5例,無轉(zhuǎn)移4例。對于前哨淋巴結(jié)陽性的病例,術(shù)前專項超聲診斷腋下淋巴結(jié)有轉(zhuǎn)移和無轉(zhuǎn)移兩組間非前哨淋巴結(jié)轉(zhuǎn)移的發(fā)生率無顯著統(tǒng)計學(xué)差異(P0.05)。結(jié)論：術(shù)前專項常規(guī)超聲對于臨床體檢腋窩陰性的早期浸潤性乳腺癌前哨淋巴結(jié)轉(zhuǎn)移情況有一定的診斷價值；前哨淋巴結(jié)活檢聯(lián)合術(shù)前腋下專項超聲不能預(yù)測非前哨淋巴結(jié)的轉(zhuǎn)移狀態(tài)。第二部分前后兩次超聲、磁共振、鉬靶對早期乳腺癌腋-下淋巴結(jié)評估價值比較目的：比較前后兩次超聲(浸潤性乳腺癌確診前腋下常規(guī)超聲和浸潤性乳腺癌確診后術(shù)前腋下專項超聲)、磁共振(MR)、鉬靶(MG)之間對臨床體檢腋窩陰性乳腺癌腋下淋巴結(jié)轉(zhuǎn)移情況的評估價值。方法：對本組病例行兩次腋下超聲,即浸潤性乳腺癌確診前腋下常規(guī)超聲和浸潤性乳腺癌確診后腋下專項超聲。常規(guī)超聲在超聲科門診完成,診斷醫(yī)師隨機(jī)。專項超聲于乳腺癌確診后術(shù)前指定我院超聲診斷科一名高年制醫(yī)師對腋下進(jìn)行有針對性的掃查；回顧性分析常規(guī)超聲、術(shù)前專項超聲、磁共振(MR)和鉬靶(MG)對于本組病例腋下淋巴結(jié)的診斷結(jié)果,比較其對轉(zhuǎn)移性腋下淋巴結(jié)的診斷效能。評價指標(biāo)包括靈敏度、特異度、陽性預(yù)測值、陰性預(yù)測值、準(zhǔn)確性。結(jié)果：本組96例病例均接受兩次超聲檢查,79例接受MR檢查,90接受MG檢查；常規(guī)超聲診斷腋下轉(zhuǎn)移性淋巴結(jié)靈敏度23.5%,特異度100%,陽性預(yù)測值100%,陰性預(yù)測值85.9%,準(zhǔn)確度86.5%;專項超聲診斷腋下轉(zhuǎn)移性淋巴結(jié)靈敏度、特異度、陽性預(yù)測值、陰性預(yù)測值、準(zhǔn)確性分別為：47.1%、88.6%、47.1%、88.6%、81.3%；MR為13.3%、96.9%、50%、82.7%、81.0%；MG為5.9%,95.9%、25.0%、81.4%、78.9%。結(jié)論：相比較常規(guī)超聲,術(shù)前專項超聲診斷腋下轉(zhuǎn)移性淋巴結(jié)靈敏度有所升高,但是特異性有所下降。對于臨床體檢陰性的早期浸潤性乳腺癌,在腋下轉(zhuǎn)移性淋巴結(jié)檢出率上,超聲要優(yōu)于MG和MR。
[Abstract]:The first part of the preoperative diagnostic value of ultrasound for special axillary lymph nodes in breast cancer early preliminary study objective: To investigate the effectiveness of preoperative ultrasound in the diagnosis of special clinical examination negative axillary sentinel lymph metastasis, and sentinel lymph node biopsy combined with preoperative ultrasound for breast cancer specific non predictive ability of sentinel lymph node metastasis cases methods: for primary breast lesions of coarse needle biopsy were diagnosed as invasive cancer cases, preoperative high year a physician to its axillary targeted scan. Ultrasonographic diagnosis of axillary lymph node metastasis diagnosis standard including low echo, irregular or full, the boundary is not clear, hiler structure is not clear, not homogeneous cortex thickening. All lymph nodes all ultrasound findings are in line with the benign diagnosis of axillary lymph node metastasis, whereas the diagnosis of axillary lymph node metastasis. Ultrasound diagnosis The result of fault and the pathological results, analysis of preoperative ultrasonography and special sentinel lymph node metastasis coincidence rate, as well as special preoperative ultrasound combined with sentinel lymph node biopsy and non sentinel lymph node metastasis in the coincidence rate. Results: in group a total of 96 cases of pathologically confirmed 17 cases of metastatic sentinel lymph node, sentinel lymph node node metastasis incidence of 17.7%. special preoperative ultrasound diagnosis of axillary lymph node metastasis in 17 cases, 8 were true positive. Preoperative ultrasound diagnostic sensitivity of 47.1% special sentinel lymph node metastasis, specificity 88.6%, positive predictive value of 47.1%, negative predictive value of 88.6%, accuracy of 81.3%. sentinel lymph node positive cases, ultrasound diagnosis of 8 cases with metastasis of axillary lymph node, including non sentinel lymph node metastasis in 5 cases, 3 cases without metastasis; ultrasonographic diagnosis of axillary lymph node metastasis in 9 cases, including non sentinel lymph node metastasis in 5 cases, 4 cases without metastasis. In the sentinel lymph node positive cases, preoperative ultrasound diagnosis has special metastasis and no metastasis between the two groups of non sentinel lymph node metastasis incidence was no significant difference of axillary lymph node (P0.05). Conclusion: preoperative ultrasound for early clinical examination special negative axillary invasive breast cancer sentinel lymph node metastasis. A diagnostic value; Sentinel lymph node metastasis axillary ultrasound can not predict the special status of non sentinel lymph node biopsy combined with preoperative. The second part is two times before and after ultrasound, magnetic resonance imaging, mammography for early breast cancer axillary lymph node under the assessed value objective to compare two times before and after ultrasound (invasive breast cancer diagnosed before the armpit conventional ultrasound and invasive breast cancer diagnosed after preoperative axillary ultrasound), special magnetic resonance (MR), molybdenum (MG) on the clinical examination of axillary lymph node negative breast cancer metastasis situation assessment The value of this group. Methods: two cases of axillary ultrasound, which is invasive breast cancer diagnosed before axillary ultrasound and invasive breast cancer diagnosed after axillary ultrasound. Ultrasound in special outpatient department of ultrasound, ultrasound diagnosis physicians randomly. Special in the designated department of ultrasound in our hospital a year high physician of the armpit targeted scan after a breast cancer diagnosis before surgery; retrospective analysis of routine preoperative ultrasound, special ultrasound, magnetic resonance imaging (MR) and molybdenum target (MG) for the diagnosis results in the cases of axillary lymph nodes, compare the diagnostic efficacy of metastatic axillary lymph nodes. The evaluation index including sensitivity. The specificity, positive predictive value, negative predictive value, accuracy. Results: 96 cases of this group underwent two ultrasound examination, 79 cases underwent MR, 90 underwent MG; conventional ultrasound in the diagnosis of axillary metastatic lymph node sensitivity 23.5%, specificity 100% 100%, positive predictive value, negative predictive value of 85.9%, accuracy 86.5%; special ultrasound in the diagnosis of axillary metastatic lymph node sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 47.1%, 88.6%, 47.1%, 88.6%, 81.3%; MR 13.3%, 96.9%, 50%, 82.7%, 81%; MG 5.9%, 95.9%, 25%, 81.4%, 78.9%.. Conclusion: compared with conventional ultrasound, preoperative ultrasound diagnosis of special axillary metastatic lymph node sensitivity was increased, but the specificity decreased. For the early clinical examination negative invasive breast cancer, in axillary metastatic lymph nodes and the detection rate of ultrasound was better than that of MG and MR.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R737.9

【共引文獻(xiàn)】

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