术前超声对于临床体检腋窝阴性乳腺癌腋下淋巴结评估价值初步探讨

发布时间：2018-02-27 02:13

本文关键词： 超声乳腺癌淋巴结　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分术前专项超声对于-早期乳腺癌腋下淋巴结诊断价值初步探讨目的：探讨术前专项超声对于临床体检腋窝阴性乳腺癌前哨淋巴转移状态的诊断效能,以及前哨淋巴结活检联合术前专项超声对乳腺癌非前哨淋巴结转移情况的预测能力。方法：对于乳腺原发病灶粗针穿刺活检确诊为浸润性癌的病例,于术前一名高年制医师对其腋下进行有针对性的扫查。超声诊断腋下淋巴结转移的诊断标准包括回声低、形态不规则或饱满、边界不清、淋巴门结构不清、皮质不均质增厚。所有淋巴结所有超声征象均符合良性则诊断为腋下淋巴结无转移,反之则诊断为腋下淋巴结有转移。超声诊断结果与病理结果对照,分析术前专项超声与前哨淋巴结转移情况的符合率,以及术前专项超声联合前哨淋巴结活检与非前哨淋巴结转移状态的符合率。结果：入组共96例病例,病理证实前哨淋巴结有转移17例,前哨淋巴结转移发生率17.7%。术前专项超声诊断为腋下淋巴结有转移17例,其中真阳性8例。术前专项超声诊断前哨淋巴结转移的灵敏度47.1%,特异度88.6%,阳性预测值47.1%,阴性预测值88.6%,准确度81.3%。前哨淋巴结阳性的病例中,超声诊断为腋下淋巴结有转移8例,其中非前哨淋巴结有转移5例,无转移3例；超声诊断腋下淋巴结无转移病例9例,其中非前哨淋巴结有转移5例,无转移4例。对于前哨淋巴结阳性的病例,术前专项超声诊断腋下淋巴结有转移和无转移两组间非前哨淋巴结转移的发生率无显著统计学差异(P0.05)。结论：术前专项常规超声对于临床体检腋窝阴性的早期浸润性乳腺癌前哨淋巴结转移情况有一定的诊断价值；前哨淋巴结活检联合术前腋下专项超声不能预测非前哨淋巴结的转移状态。第二部分前后两次超声、磁共振、钼靶对早期乳腺癌腋-下淋巴结评估价值比较目的：比较前后两次超声(浸润性乳腺癌确诊前腋下常规超声和浸润性乳腺癌确诊后术前腋下专项超声)、磁共振(MR)、钼靶(MG)之间对临床体检腋窝阴性乳腺癌腋下淋巴结转移情况的评估价值。方法：对本组病例行两次腋下超声,即浸润性乳腺癌确诊前腋下常规超声和浸润性乳腺癌确诊后腋下专项超声。常规超声在超声科门诊完成,诊断医师随机。专项超声于乳腺癌确诊后术前指定我院超声诊断科一名高年制医师对腋下进行有针对性的扫查；回顾性分析常规超声、术前专项超声、磁共振(MR)和钼靶(MG)对于本组病例腋下淋巴结的诊断结果,比较其对转移性腋下淋巴结的诊断效能。评价指标包括灵敏度、特异度、阳性预测值、阴性预测值、准确性。结果：本组96例病例均接受两次超声检查,79例接受MR检查,90接受MG检查；常规超声诊断腋下转移性淋巴结灵敏度23.5%,特异度100%,阳性预测值100%,阴性预测值85.9%,准确度86.5%;专项超声诊断腋下转移性淋巴结灵敏度、特异度、阳性预测值、阴性预测值、准确性分别为：47.1%、88.6%、47.1%、88.6%、81.3%；MR为13.3%、96.9%、50%、82.7%、81.0%；MG为5.9%,95.9%、25.0%、81.4%、78.9%。结论：相比较常规超声,术前专项超声诊断腋下转移性淋巴结灵敏度有所升高,但是特异性有所下降。对于临床体检阴性的早期浸润性乳腺癌,在腋下转移性淋巴结检出率上,超声要优于MG和MR。
[Abstract]:The first part of the preoperative diagnostic value of ultrasound for special axillary lymph nodes in breast cancer early preliminary study objective: To investigate the effectiveness of preoperative ultrasound in the diagnosis of special clinical examination negative axillary sentinel lymph metastasis, and sentinel lymph node biopsy combined with preoperative ultrasound for breast cancer specific non predictive ability of sentinel lymph node metastasis cases methods: for primary breast lesions of coarse needle biopsy were diagnosed as invasive cancer cases, preoperative high year a physician to its axillary targeted scan. Ultrasonographic diagnosis of axillary lymph node metastasis diagnosis standard including low echo, irregular or full, the boundary is not clear, hiler structure is not clear, not homogeneous cortex thickening. All lymph nodes all ultrasound findings are in line with the benign diagnosis of axillary lymph node metastasis, whereas the diagnosis of axillary lymph node metastasis. Ultrasound diagnosis The result of fault and the pathological results, analysis of preoperative ultrasonography and special sentinel lymph node metastasis coincidence rate, as well as special preoperative ultrasound combined with sentinel lymph node biopsy and non sentinel lymph node metastasis in the coincidence rate. Results: in group a total of 96 cases of pathologically confirmed 17 cases of metastatic sentinel lymph node, sentinel lymph node node metastasis incidence of 17.7%. special preoperative ultrasound diagnosis of axillary lymph node metastasis in 17 cases, 8 were true positive. Preoperative ultrasound diagnostic sensitivity of 47.1% special sentinel lymph node metastasis, specificity 88.6%, positive predictive value of 47.1%, negative predictive value of 88.6%, accuracy of 81.3%. sentinel lymph node positive cases, ultrasound diagnosis of 8 cases with metastasis of axillary lymph node, including non sentinel lymph node metastasis in 5 cases, 3 cases without metastasis; ultrasonographic diagnosis of axillary lymph node metastasis in 9 cases, including non sentinel lymph node metastasis in 5 cases, 4 cases without metastasis. In the sentinel lymph node positive cases, preoperative ultrasound diagnosis has special metastasis and no metastasis between the two groups of non sentinel lymph node metastasis incidence was no significant difference of axillary lymph node (P0.05). Conclusion: preoperative ultrasound for early clinical examination special negative axillary invasive breast cancer sentinel lymph node metastasis. A diagnostic value; Sentinel lymph node metastasis axillary ultrasound can not predict the special status of non sentinel lymph node biopsy combined with preoperative. The second part is two times before and after ultrasound, magnetic resonance imaging, mammography for early breast cancer axillary lymph node under the assessed value objective to compare two times before and after ultrasound (invasive breast cancer diagnosed before the armpit conventional ultrasound and invasive breast cancer diagnosed after preoperative axillary ultrasound), special magnetic resonance (MR), molybdenum (MG) on the clinical examination of axillary lymph node negative breast cancer metastasis situation assessment The value of this group. Methods: two cases of axillary ultrasound, which is invasive breast cancer diagnosed before axillary ultrasound and invasive breast cancer diagnosed after axillary ultrasound. Ultrasound in special outpatient department of ultrasound, ultrasound diagnosis physicians randomly. Special in the designated department of ultrasound in our hospital a year high physician of the armpit targeted scan after a breast cancer diagnosis before surgery; retrospective analysis of routine preoperative ultrasound, special ultrasound, magnetic resonance imaging (MR) and molybdenum target (MG) for the diagnosis results in the cases of axillary lymph nodes, compare the diagnostic efficacy of metastatic axillary lymph nodes. The evaluation index including sensitivity. The specificity, positive predictive value, negative predictive value, accuracy. Results: 96 cases of this group underwent two ultrasound examination, 79 cases underwent MR, 90 underwent MG; conventional ultrasound in the diagnosis of axillary metastatic lymph node sensitivity 23.5%, specificity 100% 100%, positive predictive value, negative predictive value of 85.9%, accuracy 86.5%; special ultrasound in the diagnosis of axillary metastatic lymph node sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 47.1%, 88.6%, 47.1%, 88.6%, 81.3%; MR 13.3%, 96.9%, 50%, 82.7%, 81%; MG 5.9%, 95.9%, 25%, 81.4%, 78.9%.. Conclusion: compared with conventional ultrasound, preoperative ultrasound diagnosis of special axillary metastatic lymph node sensitivity was increased, but the specificity decreased. For the early clinical examination negative invasive breast cancer, in axillary metastatic lymph nodes and the detection rate of ultrasound was better than that of MG and MR.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R737.9

【共引文献】