發(fā)布時(shí)間：2018-02-10 02:47

  本文關(guān)鍵詞： 前哨淋巴結(jié) 超聲造影 增強(qiáng)模式 乳腺癌 前哨淋巴結(jié) 前哨淋巴結(jié)活檢 超聲造影 細(xì)針穿刺活檢 乳腺癌　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的乳腺癌術(shù)前超聲造影定位腋窩前哨淋巴結(jié),并探索增強(qiáng)模式對(duì)前哨淋巴結(jié)轉(zhuǎn)移的預(yù)測(cè)價(jià)值。方法研究共入組組織學(xué)診斷為乳腺癌且常規(guī)超聲診斷無淋巴結(jié)轉(zhuǎn)移的患者110例。經(jīng)乳暈邊緣皮下注射超聲造影劑Sonovue,追蹤顯影淋巴管至SLNs并定位,觀察SLNs增強(qiáng)模式,手術(shù)采用藍(lán)染法及吲哚菁綠定位前哨淋巴結(jié)。以手術(shù)及手術(shù)病理結(jié)果為金標(biāo)準(zhǔn),判斷超聲造影定位SLN的準(zhǔn)確性,及造影模式對(duì)淋巴結(jié)轉(zhuǎn)移的診斷準(zhǔn)確性。結(jié)果110例患者中,106例患者在術(shù)前超聲造影發(fā)現(xiàn)增強(qiáng)134個(gè)SLNs,定位成功率達(dá)96.4%。其中,Ⅰ型增強(qiáng)模式(均勻增強(qiáng))51個(gè),經(jīng)病理證實(shí)均為良性淋巴結(jié);Ⅱ型增強(qiáng)模式(不均勻增強(qiáng))76個(gè),29個(gè)轉(zhuǎn)移性淋巴結(jié),47個(gè)良性淋巴結(jié);Ⅲ型增強(qiáng)模式(無增強(qiáng))7個(gè),均為轉(zhuǎn)移性淋巴結(jié)。將Ⅰ型增強(qiáng)模式判定為良性淋巴結(jié),Ⅱ、Ⅲ型增強(qiáng)模式判定為轉(zhuǎn)移性淋巴結(jié),超聲造影增強(qiáng)模式診斷SLNs的敏感度100%,特異度52.0%,陽性預(yù)測(cè)值43.4%,陰性預(yù)測(cè)值100%,準(zhǔn)確率64.9%。結(jié)論乳腺癌術(shù)前超聲造影可準(zhǔn)確定位腋窩SLNs,Ⅰ型增強(qiáng)模式對(duì)SLNs陰性預(yù)測(cè)價(jià)值高;Ⅲ型增強(qiáng)模式對(duì)SLNs陽性預(yù)測(cè)價(jià)值高;不均勻增強(qiáng)的SLNs良惡性重疊度高,僅靠造影增強(qiáng)模式無法準(zhǔn)確預(yù)測(cè)淋巴結(jié)狀態(tài)。目的探索腋窩前哨淋巴結(jié)超聲造影結(jié)合細(xì)針穿刺活檢(FNA)對(duì)乳腺癌患者前哨淋巴結(jié)轉(zhuǎn)移的診斷價(jià)值。方法研究共入組63例組織學(xué)診斷為乳腺癌且常規(guī)超聲診斷無淋巴結(jié)轉(zhuǎn)移的患者,經(jīng)乳暈邊緣皮下注射超聲造影劑Sonovue,追蹤顯影淋巴管至SLNs并定位,觀察SLNs增強(qiáng)模式,并對(duì)前哨淋巴結(jié)細(xì)針穿刺活檢送病理。手術(shù)采用藍(lán)染法及吲哚菁綠定位前哨淋巴結(jié)。以手術(shù)及手術(shù)病理結(jié)果為金標(biāo)準(zhǔn),判定超聲造影結(jié)合FNA對(duì)淋巴結(jié)轉(zhuǎn)移的準(zhǔn)確性。結(jié)果63例患者中,60例患者成功行超聲造影發(fā)現(xiàn)73個(gè)前哨淋巴結(jié)。Ⅰ型增強(qiáng)模式(均勻增強(qiáng))25例,FNA結(jié)果23例SLNs陰性,2例SLNs可疑陽性,手術(shù)病理均為陰性淋巴結(jié);Ⅱ型增強(qiáng)模式(不均勻增強(qiáng))42例,15例SLNs FNA及手術(shù)病理陽性,27例SLNs FNA陰性,其中6例手術(shù)病理陽性;Ⅲ型增強(qiáng)模式(無或弱增強(qiáng))6例,FNA及手術(shù)病理均為陽性淋巴結(jié)。超聲造影結(jié)合FNA預(yù)測(cè)前哨淋巴結(jié)轉(zhuǎn)移的敏感度71.4%,特異度100%,陽性預(yù)測(cè)值100%,陰性預(yù)測(cè)值89.7%,準(zhǔn)確度91.8%。結(jié)論超聲造影結(jié)合細(xì)針穿刺活檢可在術(shù)前較準(zhǔn)確地評(píng)估乳腺癌患者前哨淋巴結(jié)轉(zhuǎn)移的風(fēng)險(xiǎn)。這一方法將來有望應(yīng)用于臨床。
[Abstract]:Objective to locate axillary sentinel lymph nodes by contrast-enhanced ultrasonography before breast cancer. To explore the predictive value of enhancement model for sentinel lymph node metastasis. Methods 110 patients with breast cancer diagnosed by histologically and conventional ultrasound without lymph node metastasis were studied. Subcutaneous injection of ultrasound contrast agent via the edge of areola was performed in 110 patients without lymph node metastasis. Sonovue, trace the developed lymphatic vessels to SLNs and locate, To observe the enhancement mode of SLNs, blue staining and indocyanine green were used to locate the sentinel lymph nodes, and the accuracy of SLN localization by contrast-enhanced ultrasonography was evaluated according to the results of operation and pathology as gold standard. Results the enhancement of 134 SLNs was found in 106 out of 110 patients with lymph node metastasis, and the localization success rate was 96.44.Among them, 51 were type 鈪，

本文編號(hào)：1499477