本文關(guān)鍵詞： 前哨淋巴結(jié) 超聲造影 增強模式 乳腺癌 前哨淋巴結(jié) 前哨淋巴結(jié)活檢 超聲造影 細針穿刺活檢 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),并探索增強模式對前哨淋巴結(jié)轉(zhuǎn)移的預(yù)測價值。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增強模式,手術(shù)采用藍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)果為金標準,判斷超聲造影定位SLN的準確性,及造影模式對淋巴結(jié)轉(zhuǎn)移的診斷準確性。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134個SLNs,定位成功率達96.4%。其中,Ⅰ型增強模式(均勻增強)51個,經(jīng)病理證實均為良性淋巴結(jié);Ⅱ型增強模式(不均勻增強)76個,29個轉(zhuǎn)移性淋巴結(jié),47個良性淋巴結(jié);Ⅲ型增強模式(無增強)7個,均為轉(zhuǎn)移性淋巴結(jié)。將Ⅰ型增強模式判定為良性淋巴結(jié),Ⅱ、Ⅲ型增強模式判定為轉(zhuǎn)移性淋巴結(jié),超聲造影增強模式診斷SLNs的敏感度100%,特異度52.0%,陽性預(yù)測值43.4%,陰性預(yù)測值100%,準確率64.9%。結(jié)論乳腺癌術(shù)前超聲造影可準確定位腋窩SLNs,Ⅰ型增強模式對SLNs陰性預(yù)測價值高;Ⅲ型增強模式對SLNs陽性預(yù)測價值高;不均勻增強的SLNs良惡性重疊度高,僅靠造影增強模式無法準確預(yù)測淋巴結(jié)狀態(tài)。目的探索腋窩前哨淋巴結(jié)超聲造影結(jié)合細針穿刺活檢(FNA)對乳腺癌患者前哨淋巴結(jié)轉(zhuǎn)移的診斷價值。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增強模式,并對前哨淋巴結(jié)細針穿刺活檢送病理。手術(shù)采用藍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)果為金標準,判定超聲造影結(jié)合FNA對淋巴結(jié)轉(zhuǎn)移的準確性。結(jié)果63例患者中,60例患者成功行超聲造影發(fā)現(xiàn)73個前哨淋巴結(jié)。Ⅰ型增強模式(均勻增強)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型增強模式(不均勻增強)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型增強模式(無或弱增強)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)測前哨淋巴結(jié)轉(zhuǎn)移的敏感度71.4%,特異度100%,陽性預(yù)測值100%,陰性預(yù)測值89.7%,準確度91.8%。結(jié)論超聲造影結(jié)合細針穿刺活檢可在術(shù)前較準確地評估乳腺癌患者前哨淋巴結(jié)轉(zhuǎn)移的風(fēng)險。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：1499477