本文選題：超聲造影　切入點(diǎn)：乳腺癌　出處：《蘇州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的評(píng)價(jià)超聲造影對(duì)乳腺癌患者良惡性腋窩淋巴結(jié)鑒別診斷的價(jià)值，并分析乳腺癌原發(fā)灶聲像特點(diǎn)與腋窩淋巴結(jié)轉(zhuǎn)移的相關(guān)性。 方法2010年9月～2013年2月我院收住入院的46例乳腺癌患者，共82個(gè)腋窩腫大淋巴結(jié)，均有手術(shù)病理結(jié)果，首先對(duì)46例患者進(jìn)行超聲常規(guī)掃查，二維灰階超聲重點(diǎn)觀察乳腺腫塊的大小、形態(tài)、內(nèi)部有無(wú)沙粒樣鈣化、腋窩淋巴結(jié)大小、形態(tài)、長(zhǎng)/短徑(L/S)比值及內(nèi)部結(jié)構(gòu)；彩色多普勒血流顯像(color Doppler flow imaging, CDFI）重點(diǎn)觀察淋巴結(jié)內(nèi)血流分布情況，并測(cè)定血流阻力指數(shù)（resistance index, RI）及動(dòng)脈峰值流速（maximum velocity, Vmax）。46例乳腺癌患者同期進(jìn)行腋窩淋巴結(jié)超聲造影檢查，，記錄并分析造影強(qiáng)化模式，并與術(shù)后病理結(jié)果相對(duì)照。采用卡方檢驗(yàn)觀察轉(zhuǎn)移與非轉(zhuǎn)移淋巴結(jié)各項(xiàng)指標(biāo)的差異，采用一元相關(guān)分析分析各指標(biāo)和腋窩轉(zhuǎn)移淋巴結(jié)的相關(guān)性。 結(jié)果常規(guī)超聲檢查結(jié)果顯示：75.0%的轉(zhuǎn)移性淋巴結(jié)L/S＜2，18.1%的非轉(zhuǎn)移性淋巴結(jié)L/S＜2（P＜0.01）。淋巴結(jié)皮質(zhì)增厚型、皮質(zhì)狹窄型、無(wú)淋巴門型在轉(zhuǎn)移組分別占72.5%、9.8%及17.7%；良性組分別占22.6%、77.4%及0%（P＜0.01）。淋巴結(jié)呈周邊型血流分布在轉(zhuǎn)移組占70.6%，良性組占12.9%（P＜0.01）。兩組RI差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。超聲造影結(jié)果顯示：轉(zhuǎn)移性淋巴結(jié)不均勻強(qiáng)化占82.4%，而良性淋巴結(jié)為不均勻強(qiáng)化僅占3.2%（P＜0.01）。與病理結(jié)果相對(duì)照，常規(guī)超聲診斷腋窩淋巴結(jié)良惡性的敏感性、特異性及準(zhǔn)確性分別為78.4%、75.0%及76.8%；超聲造影診斷腋窩淋巴結(jié)良惡性的敏感性、特異性及準(zhǔn)確性分別為90.2%、90.3%及90.2%，與常規(guī)超聲檢查比較，兩組間差異有統(tǒng)計(jì)學(xué)意義（P0.05）。相關(guān)分析結(jié)果顯示，乳腺癌原發(fā)灶的最大徑≥2cm、淋巴結(jié)長(zhǎng)短比(L/S)＜2等均與乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移有相關(guān)性（P＜0.05）。 結(jié)論 1.超聲造影在判斷乳腺癌腋窩淋巴結(jié)良惡性方面的價(jià)值優(yōu)于常規(guī)超聲。 2.原發(fā)灶的最大徑≥2cm者，腋窩淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)高，原發(fā)灶有無(wú)微鈣化與腋窩淋巴結(jié)轉(zhuǎn)移無(wú)明顯相關(guān)性。 3.腋窩淋巴結(jié)呈皮質(zhì)增厚型或無(wú)淋巴結(jié)門型結(jié)構(gòu)、淋巴結(jié)L/S＜2、非門型血流、非均勻強(qiáng)化等征象高度提示轉(zhuǎn)移。
[Abstract]:Objective to evaluate the value of contrast-enhanced ultrasonography in differential diagnosis of benign and malignant axillary lymph nodes in patients with breast cancer, and to analyze the correlation between sonographic features of primary breast cancer and axillary lymph node metastasis. Methods Forty-six patients with breast cancer admitted to our hospital from September 2010 to February 2013, 82 axillary lymph nodes, all had surgical and pathological results. Two-dimensional gray scale ultrasound was used to observe the size, shape, sand calcification, axillary lymph node size, shape, long / short diameter L / S ratio and internal structure of breast masses. Color Doppler flow imaging (CDFI) was used to observe the distribution of blood flow in lymph nodes, and the index of blood flow resistance (RI), peak arterial velocity and maximum velocitywere measured. The axillary lymph nodes were examined by contrast-enhanced ultrasonography in the same period in Vmax).46 patients with breast cancer. The enhancement pattern of angiography was recorded and analyzed, and compared with the pathological results after operation. The differences between the indexes of metastatic and non-metastatic lymph nodes were observed by chi-square test, and the correlation between each index and axillary metastatic lymph nodes was analyzed by univariate correlation analysis. Results the results of conventional ultrasonography showed that 75.0% of the metastatic lymph nodes L / S < 2% and 18.1% of the non-metastatic lymph nodes L / S < 2% P < 0.01%. The cortical thickening type and the cortical stenosis type of lymph nodes were found in 75.0% of the metastatic lymph nodes and 18.1% of the non-metastatic lymph nodes. The percentage of lymphatic hilar type in metastasis group was 72.5% and 17.70.The benign group accounted for 22.67.4% and 0%, respectively (P < 0.01). The lymph nodes showed peripheral blood flow distribution in metastasis group (70.6%) and benign group (12.9%) (P < 0.01). There was no significant difference in RI between the two groups (P > 0.05). The proportion of non-uniform enhancement of lymph nodes was 82.4%, while that of benign lymph nodes was only 3.2% (P < 0.01). The sensitivity, specificity and accuracy of conventional ultrasonography in the diagnosis of benign and malignant axillary lymph nodes were 78.4% and 76.80.The sensitivity, specificity and accuracy of contrast-enhanced ultrasonography in the diagnosis of benign and malignant axillary lymph nodes were 90.3% and 90.2%, respectively. There was a significant difference between the two groups (P < 0.05). The results of correlation analysis showed that the maximum diameter of primary breast cancer was more than 2 cm, the length of lymph node was less than 2, and there was a correlation between the two groups and axillary lymph node metastasis of breast cancer (P < 0.05). Conclusion. 1. Contrast-enhanced ultrasonography is superior to conventional ultrasonography in the diagnosis of benign and malignant axillary lymph nodes in breast cancer. 2. There was a high risk of axillary lymph node metastasis in the patients with the maximum diameter 鈮

本文編號(hào)：1581598