發(fā)布時間：2018-05-08 11:06

  本文選題：乳腺癌 + 前哨淋巴結(jié)　； 參考：《廣州中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：目的： 評估常規(guī)超聲(Conventional Ultrasound, US, B型超聲+彩色多普勒超聲)、經(jīng)皮內(nèi)注射超聲造影(Contrast Enhanced Ultrasound, CEUS)聯(lián)合常規(guī)超聲對乳腺癌前哨淋巴結(jié)(Sentinel Lymph Node, SLN)的診斷價值。方法： 對42例乳腺癌患者進(jìn)行常規(guī)超聲檢查,了解乳腺腫塊及腋窩淋巴結(jié)情況,然后于乳暈旁經(jīng)皮內(nèi)注射超聲造影劑SonoVue后對引流淋巴管及SLN進(jìn)行觀察分析,CEUS檢出顯影SLN后,切換至基波模式以常規(guī)超聲方法觀察SLN。42例乳腺癌患者的SLN的常規(guī)超聲及CEUS聯(lián)合常規(guī)超聲的診斷結(jié)果,均用五級評分法(1級,無轉(zhuǎn)移；2級,可能無轉(zhuǎn)移；3級,不確定；4級,可能轉(zhuǎn)移；5級,轉(zhuǎn)移)記錄,并將兩者結(jié)果進(jìn)行比較。應(yīng)用三級評分(0,無增益,1,輕度增益,2,顯著增益)分析CEUS聯(lián)合常規(guī)超聲較常規(guī)超聲的診斷改變。最后以病理結(jié)果作為金標(biāo)準(zhǔn),比較常規(guī)超聲、CEUS和兩者聯(lián)合診斷乳腺癌SLN的準(zhǔn)確性、敏感性、特異性。應(yīng)用ROC曲線分析常規(guī)超聲、CEUS和兩者聯(lián)合對乳腺癌SLN的診斷價值。結(jié)果： 1.SLN的病理結(jié)果：42例乳腺癌患者SLN無轉(zhuǎn)移24例,有轉(zhuǎn)移18例。采用CEUS檢測42例患者SLN,其中29例患者共檢出34個SLN,無轉(zhuǎn)移23個,有轉(zhuǎn)移11個；其余13例患者未檢出SLN,有轉(zhuǎn)移8例,無轉(zhuǎn)移5例。在超聲造影檢查基礎(chǔ)上,采用常規(guī)超聲檢測42例患者SLN,其中38例患者共檢出43個SLN,無轉(zhuǎn)移25個,有轉(zhuǎn)移18個；其余4例患者常規(guī)超聲未檢出SLN,3例無轉(zhuǎn)移,1例有轉(zhuǎn)移。 2.SLN的超聲造影結(jié)果：42例患者,13例患者未檢出SLN,其余29例患者共檢出34個SLN,其中24例檢出1個SLN,5例檢出2個SLN,SLN檢出率72.3%(34/47)。根據(jù)SLN病理結(jié)果分為轉(zhuǎn)移組和無轉(zhuǎn)移組,轉(zhuǎn)移組和無轉(zhuǎn)移組SLN的增強(qiáng)模式差異有統(tǒng)計學(xué)意義(P0.05),轉(zhuǎn)移組多呈部分增強(qiáng)或不增強(qiáng),無轉(zhuǎn)移組多呈均勻增強(qiáng)。轉(zhuǎn)移組和無轉(zhuǎn)移組的SLN橫徑、前后徑、垂直徑、形態(tài)、淋巴管顯影時間、造影檢查所用時間、造影劑劑量之間差異均無統(tǒng)計學(xué)意義(PO.05)。 3.SLN的常規(guī)超聲結(jié)果：42例患者,4例患者未檢出SLN,其余38例患者共檢出43個SLN,其中33例檢出1個SLN,5例檢出2個SLN。轉(zhuǎn)移組SLN前后徑(7.83±2.40mm)大于無轉(zhuǎn)移組(5.21±1.55mm),轉(zhuǎn)移組長徑/短徑(1.90±0.66)小于無轉(zhuǎn)移組(2.41±1.20),差異有統(tǒng)計學(xué)意義(P0.05)。轉(zhuǎn)移組和無轉(zhuǎn)移組的SLN皮髓質(zhì)情況、血流分布情況差異有統(tǒng)計學(xué)意義(P0.05),轉(zhuǎn)移組多呈皮髓質(zhì)分界不清或皮質(zhì)局部增厚,多呈非淋巴門型血流；無轉(zhuǎn)移組多呈皮髓質(zhì)厚薄均勻,多呈淋巴門型血流。轉(zhuǎn)移組和無移組的SLN橫徑、垂直徑、形態(tài)、淋巴門情況差異無統(tǒng)計學(xué)意義(PO.05)。 4.轉(zhuǎn)移組和無轉(zhuǎn)移組的乳腺腫塊位置、橫徑、前后徑、垂直徑、彩色多普勒血流、血流阻力指數(shù)、病理類型、孕激素受體(PR)、雌激素受體(ER)、HER-2之間差異均無統(tǒng)計學(xué)意義(PO.05)。 5.常規(guī)超聲、CEUS和兩者聯(lián)合應(yīng)用診斷乳腺癌SLN的準(zhǔn)確性、敏感性、特異性分別為61.2%、36.8%、78.6%,72.3%、57.9%、82.1%和83.0%、63.1%、96.4%,常規(guī)超聲和兩者聯(lián)合應(yīng)用之間的差異有統(tǒng)計學(xué)意義(P0.05),CEUS和兩者聯(lián)合應(yīng)用之間的差異無統(tǒng)計學(xué)意義(P0.05),CEUS和常規(guī)超聲之間的差異無統(tǒng)計學(xué)意義(P0.05)。 6.常規(guī)超聲、CEUS和兩者聯(lián)合應(yīng)用診斷乳腺癌SLN的ROC曲線下面積(Area underthe curve,AUC)分別為0.70、0.72、0.89,常規(guī)超聲和CEUS聯(lián)合常規(guī)超聲的AUC差異有統(tǒng)計學(xué)意義(P0.05),CUES和CEUS聯(lián)合常規(guī)超聲的AUC差異有統(tǒng)計學(xué)意義(P0.05),CUES和常規(guī)超聲的AUC差異無統(tǒng)計學(xué)意義(P0.05)。 7.與常規(guī)超聲對比,CEUS聯(lián)合常規(guī)超聲對乳腺癌SLN有48.9%(23/47)的診斷增益。與常規(guī)超聲對比,CEUS聯(lián)合常規(guī)超聲對不同位置、不同病理類型、不同腫塊大小、不同分子亞型乳腺癌的SLN,均有診斷增益,但差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論： 1.CEUS聯(lián)合常規(guī)超聲診斷乳腺癌SLN的準(zhǔn)確性、敏感性、特異性及ROC曲線下面積大于兩種方法單獨(dú)應(yīng)用。 2.與常規(guī)超聲對比,CEUS聯(lián)合常規(guī)超聲對乳腺癌的SLN有診斷增益,提高診斷信心。
[Abstract]:Objective:
To evaluate the diagnostic value of conventional ultrasound (Conventional Ultrasound, US, B ultrasound + color Doppler ultrasound), percutaneous intradermal ultrasound (Contrast Enhanced Ultrasound, CEUS) combined with conventional ultrasound in the diagnosis of sentinel lymph node (Sentinel Lymph Node, SLN) in breast cancer.
42 cases of breast cancer were examined by routine ultrasonography to understand the breast lumps and axillary lymph nodes. Then the drainage lymphatic vessels and SLN were observed and analyzed after the intradermal injection of ultrasound contrast agent SonoVue. After CEUS detected the developing SLN, the normal ultrasonic method was used to observe the SLN of the breast cancer patients in SLN.42 cases. The diagnostic results of conventional ultrasound and CEUS combined with conventional ultrasound were measured by the five grade score (Level 1, no transfer, grade 2, no transfer, 3, undetermined, 4, possible transfer, 5, transfer), and compared the results. The application of the three grade score (0, no gain, 1, mild gain, 2, significant gain) analysis of CEUS combined conventional ultrasound was more conventional. Diagnostic changes of ultrasound. Finally, the diagnostic value, sensitivity and specificity of conventional ultrasound, CEUS and combined diagnosis of breast cancer SLN were compared with the pathological results as the gold standard. The diagnostic value of conventional ultrasound, CEUS and the combination of both CEUS and the combination of CEUS and both on the diagnosis of breast cancer SLN.
The pathological results of 1.SLN: 24 cases without metastasis and 18 cases of metastasis in 42 cases of breast cancer. 42 patients with SLN were detected by CEUS. 34 SLN was detected in 29 cases, 23 were transferred without metastasis and 11 in the other 13 cases, 8 cases and 5 metastases were not detected in the other 13 patients. On the basis of ultrasound contrast examination, routine ultrasonography was used to detect 42 patients S. LN, of which 38 patients were detected 43 SLN, 25 without metastasis, 18 with metastasis, the remaining 4 patients were not detected by conventional ultrasound SLN, 3 cases without metastasis, 1 cases of metastasis.
2.SLN ultrasound contrast results: 42 patients, 13 cases were not detected SLN, the other 29 cases were detected 34 SLN, of which 24 cases detected 1 SLN, 5 cases were 2 SLN, SLN detection rate 72.3% (34/47). According to SLN pathological results were divided into the transfer group and no metastasis group, the difference of the enhancement pattern of SLN in the transfer group and the non transfer group was statistically significant (P0.05), the difference was statistically significant (P0.05). The migration group was mostly enhanced or not enhanced, and the non metastasis group was more homogeneous. The SLN transverse diameter, the front and back diameter, the vertical diameter, the shape, the time of lymphatic development and the time used in the contrast examination were not statistically significant (PO.05).
3.SLN routine ultrasound results: 42 patients, 4 cases were not detected SLN, the other 38 cases were detected 43 SLN, of which 33 cases detected 1 SLN, 5 cases were detected in 2 SLN. metastasis group (7.83 + 2.40mm) larger than no metastasis group (5.21 + 1.55mm), the metastasis group length / short diameter (1.90 + 0.66) was less than no metastasis group (2.41 + 1.20), the difference was statistically significant. (P0.05) the distribution of the blood flow in the SLN medulla in the transfer group and the non transfer group had a significant difference (P0.05). The metastasis group was mostly the demarcation of the medulla and the partial thickening of the cortex, most of the non lymphatic portal blood flow; the non metastasis group was most of the skin and medulla thick and thin, most of the lymphatic portal blood flow. The SLN transverse diameter of the transfer group and the non shift group was vertical, vertical. There was no significant difference in diameter, morphology and lymphatic status (PO.05).
4. the location of breast mass, transverse diameter, anterior and posterior diameter, vertical diameter, color Doppler blood flow, blood flow resistance index, pathological type, progesterone receptor (PR), estrogen receptor (ER), and HER-2 were not statistically significant (PO.05).
5. the accuracy of diagnosis of breast cancer SLN with conventional ultrasound, CEUS and the combination of the two, sensitivity, specificity were 61.2%, 36.8%, 78.6%, 72.3%, 57.9%, 82.1% and 83%, 63.1%, 96.4%, and the difference between the conventional ultrasound and the combination of the two was statistically significant (P0.05), and the difference between CEUS and the combination of the two was not statistically significant (P0.05), CEUS There was no significant difference between conventional ultrasound and conventional ultrasound (P0.05).
6. the area under the ROC curve (Area underthe curve, AUC) for the diagnosis of breast cancer SLN (AUC) was 0.70,0.72,0.89. The difference between conventional ultrasound and CEUS combined with conventional ultrasound was statistically significant (P0.05). There was a significant difference between the conventional ultrasound and conventional ultrasound (P0.05). 6. There was no statistical significance (P0.05).
7. compared with conventional ultrasound, CEUS combined with conventional ultrasound had 48.9% (23/47) diagnostic gain for SLN of breast cancer. Compared with conventional ultrasound, CEUS combined with conventional ultrasound had diagnostic benefits for different locations, different pathological types, different mass sizes, and SLN of different molecular subtypes of breast cancer, but the difference was not statistically significant (P0.05).
The accuracy, sensitivity, specificity and the area under the ROC curve of 1.CEUS combined with conventional ultrasound in the diagnosis of breast cancer SLN were greater than two methods alone.
2. compared with conventional ultrasound, CEUS combined with conventional ultrasound has a diagnostic gain for breast cancer SLN and improves diagnostic confidence.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R737.9

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