本文選題：乳腺癌 + 超聲��； 參考：《中國人民解放軍軍事醫(yī)學(xué)科學(xué)院》2015年碩士論文

【摘要】：研究背景：乳腺癌是女性最常見的惡性腫瘤。隨著研究的逐步深入,乳腺癌的治療已進入到了個體化綜合治療時代。乳腺癌的外科手術(shù)治療更是由最早的Halsted術(shù)式向現(xiàn)代微創(chuàng)治療轉(zhuǎn)變,即由最大的可耐受切除,轉(zhuǎn)變到現(xiàn)在的最小有效治療。目前,前哨淋巴結(jié)活檢(Sentinel lymph node biopsy, SLNB)已經(jīng)替代腋窩淋巴結(jié)的清掃(completion axillary lymph node dissection CALND)成為早期乳腺癌腋窩林巴結(jié)(Axillary lymph node, ALN)分期的金標(biāo)準(zhǔn)。對于臨床觸診陰性的患者,SLN的轉(zhuǎn)移率較低,SLN作為一種有創(chuàng)檢查會產(chǎn)生一些術(shù)后并發(fā)癥,與ALN轉(zhuǎn)移舊關(guān)的因素已經(jīng)基本明確,而對于與SLN轉(zhuǎn)移相關(guān)的因素還不十分明確。目的：回顧性分析臨床檢查ALN陰性乳腺癌患者ALN的轉(zhuǎn)移狀態(tài)。找出與ALN及SLN轉(zhuǎn)移相關(guān)的因素。方法：收集2009年1月至2013年1月我院初治臨床觸診陰性乳腺癌并行SLNB的患者357例,SLN轉(zhuǎn)移陽性患者行腋窩淋巴結(jié)清掃(Axillary lymph node dissection, ALND)。分析腫瘤T分期、分子分型與ALN及SLN轉(zhuǎn)移的相關(guān)性,術(shù)前B超判斷乳腺癌SLN轉(zhuǎn)移的診斷價值。結(jié)果：臨床ALN觸診陰性乳腺癌患者,SLN總體轉(zhuǎn)移率21.0%(75/357)；T1與T2期SLN轉(zhuǎn)移率分別為20.6%、23.7%, T分期與SLN轉(zhuǎn)移率無關(guān),P=0.54；uminal A-like型,Luminal B-like (HER2-)型,Luminal B-like (HER2+)型,HER2過表達型,三陰型SLN轉(zhuǎn)移率分別為35.0%,17.6%,25.6%,22.2%,14.3%,SLN的轉(zhuǎn)移與腫瘤分子分型無關(guān),P=0.14；B超判斷ALN轉(zhuǎn)移與實際SLN轉(zhuǎn)移的總體符合率為68.6%(245/357)；敏感性為44.0%(33/75),特異性為75.2%(212/282),陽性預(yù)測值為32.0%(33/103),陰性預(yù)測值為83.5%(212/254)假陰性率為16.5%(42/254)。當(dāng)SLN轉(zhuǎn)移陽性,B超判斷ALN轉(zhuǎn)移陽性患者的非SLN轉(zhuǎn)移率明顯高于B超判斷轉(zhuǎn)移陰性患者,非SLN轉(zhuǎn)移率分別為72.7%(16/22)、14.3%(6/42),p0.05；B超判斷ALN轉(zhuǎn)移陰性患者非SLN淋巴結(jié)轉(zhuǎn)移負(fù)荷較低,均未超過2枚。結(jié)論：ALN臨床陰性乳腺癌患者的ALN轉(zhuǎn)移率較低,其轉(zhuǎn)移率與腫瘤T分期、分子分型無關(guān)；B超可以較準(zhǔn)確判斷ALN的轉(zhuǎn)移狀態(tài)；B超判斷ALN轉(zhuǎn)移陰性實際轉(zhuǎn)移陽性患者僅有較低的淋巴結(jié)轉(zhuǎn)移負(fù)荷。
[Abstract]:Background: breast cancer is the most common malignant tumor in women. With the development of research, the treatment of breast cancer has entered the era of individualized comprehensive therapy. The surgical treatment of breast cancer has changed from the earliest Halsted operation to the modern minimally invasive treatment, that is, from the largest tolerable resection to the present minimal effective treatment. At present, sentinel lymph node biopsy, SLNB) (Sentinel lymph node biopsy, SLNB) has replaced axillary lymph node dissection (axillary lymph node dissection CALND) as the gold standard for axillary lymph node, ALN) staging in early breast cancer. For the patients with negative palpation, the metastasis rate of SLN is lower. As a invasive examination, SLN will produce some postoperative complications, and the factors related to ALN metastasis have been basically clear, but the factors related to SLN metastasis are not very clear. Objective: to retrospectively analyze the metastatic status of ALN in patients with ALN negative breast cancer. Find out the factors related to ALN and SLN metastasis. Methods: from January 2009 to January 2013, 357 patients with primary palpation negative breast cancer combined with SLNB were examined by axillary lymph node dissection, Aldd. The correlation between T stage, molecular classification and ALN and SLN metastasis was analyzed. The diagnostic value of SLN metastasis in breast cancer was evaluated by B-ultrasound before operation. Results: the overall metastatic rate of SLN in clinical ALN palpation negative breast cancer patients was 21.0% 75 / 357T 1 and 23.7%, respectively. The T stage was not related to the SLN metastasis rate. There was no correlation between T stage and SLN metastasis rate. There was no significant difference between T stage and SLN metastasis rate. The metastatic rates of SLN of the three negative type were 35.0 / 17.6 / 25.62and 22.2and 14.3N, respectively. There was no correlation between the metastasis of ALN and the molecular typing of the tumor. The overall coincidence rate of B-mode ultrasound in judging the metastasis of ALN and the actual metastasis of SLN was 68.6%. The sensitivity was 44.075%, the specificity was 75.21212282%, the positive predictive value was 32.033 / 103, and the negative predictive value was 83.521212 / 254) the false rate was 16.522544% (P = 16.52254N), and the negative predictive value was 83.521212% 2544.The false rate was 16.522540.The sensitivity was 44.075%, the specificity was 75.212282n, the positive predictive value was 32.033 / 103n, and the negative predictive value was 83.521212 / 254). When SLN metastasis was positive, the non-SLN metastasis rate of patients with positive ALN metastasis by B-ultrasound was significantly higher than that with negative metastasis by B-mode ultrasound. The non-SLN metastasis rate was 72.7 / 22 / 14.3%, respectively, and the load of non-SLN lymph node metastasis in ALN metastasis negative patients was lower than that of non-SLN lymph node metastasis. Conclusion the ALN metastasis rate of the patients with clinical negative breast cancer is lower, and the metastasis rate and T stage of the tumor are lower. Molecular typing was not significant; B-mode ultrasound could accurately judge the metastatic status of ALN; B-mode ultrasound could judge the metastatic status of ALN negative patients with actual metastasis only had lower lymph node metastasis load.
【學(xué)位授予單位】：中國人民解放軍軍事醫(yī)學(xué)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R737.9

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相關(guān)期刊論文 前1條

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本文編號：1954715