经皮超声造影提示前哨淋巴结性质对腋窝淋巴结良恶性评估的价值

发布时间：2018-01-31 06:10

本文关键词： 前哨淋巴结经皮超声造影腋窝淋巴结转移　出处：《上海交通大学学报(医学版)》2015年09期 　论文类型：期刊论文

【摘要】：目的探索经皮超声造影可否提示前哨淋巴结(SLN)性质以及对腋窝淋巴结良、恶性评估的价值。方法无菌条件下建立兔乳腺癌模型,于接种肿瘤后第6周对兔的乳腺肿块周围皮下注射造影剂,判断淋巴结的性质,并于体表进行标记;30 min后注射纳米活性炭,观察SLN超声造影表现,判断其良、恶性,并在兔体表进行标记;观察结束后处死实验动物,解剖出肿块并做腋窝淋巴结清扫,所有淋巴结送病理检查。结果10只兔20个乳腺共产生16个肿瘤,这16侧中发生转移的有11侧,未发生转移的5侧。共送检了17枚SLN,超声造影发现了94.12%(16/17)。经皮超声造影诊断恶性淋巴结灵敏度为80.0%,特异度为71.42%,阳性预测值为80.0%,阴性预测值为71.42%,准确率为76.47%。超声造影诊断恶性SLN与病理诊断差异性检测(Mc Nemar检测)P=0.688;Kappa值为0.514,P=0.034,两者具有较好的一致性。结论经皮超声造影诊断乳腺癌恶性SLN具有较高的诊断价值,可提示腋窝淋巴结转移情况。
[Abstract]:Objective to explore whether percutaneous contrast-enhanced ultrasonography can indicate the characteristics of sentinel lymph node (SLN) and its value in the evaluation of benign and malignant axillary lymph nodes. Methods A rabbit model of breast cancer was established under aseptic conditions. At the 6th week after inoculation of the tumor, the rabbit breast masses were subcutaneously injected with contrast agent to judge the nature of the lymph nodes and labeled on the body surface. After 30 min, nano-activated carbon was injected into the rabbit. The appearance of SLN contrast-enhanced ultrasound was observed, and the benign and malignant were judged and labeled on the rabbit surface. After observation, the experimental animals were killed, masses were dissected and axillary lymph nodes were dissected, all lymph nodes were sent to pathological examination. Results 16 tumors were produced in 20 mammary glands of 10 rabbits. Of the 16 sides, 11 had metastasis and 5 had no metastasis. A total of 17 SLN samples were examined. The sensitivity, specificity and positive predictive value of percutaneous contrast-enhanced ultrasonography in the diagnosis of malignant lymph nodes were 80.0, 71.42 and 80.0%, respectively. The negative predictive value was 71.42, and the accuracy was 76.47.The difference between contrast-enhanced ultrasonography in malignant SLN and pathological diagnosis was 0.688. The Kappa value was 0. 514 and 0. 034, which was in good agreement with each other. Conclusion Percutaneous contrast-enhanced ultrasonography has a high diagnostic value in the diagnosis of malignant SLN of breast cancer. It may indicate the status of axillary lymph node metastasis.
【作者单位】：上海交通大学附属第六人民医院超声医学科上海超声医学研究所;
【基金】：上海市自然科学基金(11ZR142700)~~
【分类号】：R737.9;R445.1
【正文快照】： 淋巴结转移是恶性肿瘤一项重要的生物学行为,临床上可通过淋巴结转移的部位和个数来评估肿瘤的分期[1]。恶性肿瘤一般有特定的转移路径,如甲状腺癌首先转移至颈部Ⅵ区和Ⅳ区淋巴结[2],胃癌首先转移至左锁骨上淋巴结[3,4],乳腺癌首先转移部位多见于胸肌间淋巴结和腋窝淋巴结[5]

【共引文献】