超声造影对乳腺癌腋窝淋巴结良恶性鉴别诊断价值及淋巴结转移的相关因素分析

发布时间：2018-03-08 00:18

  本文选题：超声造影　切入点：乳腺癌　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的评价超声造影对乳腺癌患者良恶性腋窝淋巴结鉴别诊断的价值，并分析乳腺癌原发灶声像特点与腋窝淋巴结转移的相关性。 方法2010年9月～2013年2月我院收住入院的46例乳腺癌患者，共82个腋窝肿大淋巴结，均有手术病理结果，首先对46例患者进行超声常规扫查，二维灰阶超声重点观察乳腺肿块的大小、形态、内部有无沙粒样钙化、腋窝淋巴结大小、形态、长/短径(L/S)比值及内部结构；彩色多普勒血流显像(color Doppler flow imaging, CDFI）重点观察淋巴结内血流分布情况，并测定血流阻力指数（resistance index, RI）及动脉峰值流速（maximum velocity, Vmax）。46例乳腺癌患者同期进行腋窝淋巴结超声造影检查，，记录并分析造影强化模式，并与术后病理结果相对照。采用卡方检验观察转移与非转移淋巴结各项指标的差异，采用一元相关分析分析各指标和腋窝转移淋巴结的相关性。 结果常规超声检查结果显示：75.0%的转移性淋巴结L/S＜2，18.1%的非转移性淋巴结L/S＜2（P＜0.01）。淋巴结皮质增厚型、皮质狭窄型、无淋巴门型在转移组分别占72.5%、9.8%及17.7%；良性组分别占22.6%、77.4%及0%（P＜0.01）。淋巴结呈周边型血流分布在转移组占70.6%，良性组占12.9%（P＜0.01）。两组RI差异无统计学意义（P＞0.05）。超声造影结果显示：转移性淋巴结不均匀强化占82.4%，而良性淋巴结为不均匀强化仅占3.2%（P＜0.01）。与病理结果相对照，常规超声诊断腋窝淋巴结良恶性的敏感性、特异性及准确性分别为78.4%、75.0%及76.8%；超声造影诊断腋窝淋巴结良恶性的敏感性、特异性及准确性分别为90.2%、90.3%及90.2%，与常规超声检查比较，两组间差异有统计学意义（P0.05）。相关分析结果显示，乳腺癌原发灶的最大径≥2cm、淋巴结长短比(L/S)＜2等均与乳腺癌腋窝淋巴结转移有相关性（P＜0.05）。 结论 1.超声造影在判断乳腺癌腋窝淋巴结良恶性方面的价值优于常规超声。 2.原发灶的最大径≥2cm者，腋窝淋巴结转移风险高，原发灶有无微钙化与腋窝淋巴结转移无明显相关性。 3.腋窝淋巴结呈皮质增厚型或无淋巴结门型结构、淋巴结L/S＜2、非门型血流、非均匀强化等征象高度提示转移。
[Abstract]:Objective to evaluate the value of contrast-enhanced ultrasonography in differential diagnosis of benign and malignant axillary lymph nodes in patients with breast cancer, and to analyze the correlation between sonographic features of primary breast cancer and axillary lymph node metastasis. Methods Forty-six patients with breast cancer admitted to our hospital from September 2010 to February 2013, 82 axillary lymph nodes, all had surgical and pathological results. Two-dimensional gray scale ultrasound was used to observe the size, shape, sand calcification, axillary lymph node size, shape, long / short diameter L / S ratio and internal structure of breast masses. Color Doppler flow imaging (CDFI) was used to observe the distribution of blood flow in lymph nodes, and the index of blood flow resistance (RI), peak arterial velocity and maximum velocitywere measured. The axillary lymph nodes were examined by contrast-enhanced ultrasonography in the same period in Vmax).46 patients with breast cancer. The enhancement pattern of angiography was recorded and analyzed, and compared with the pathological results after operation. The differences between the indexes of metastatic and non-metastatic lymph nodes were observed by chi-square test, and the correlation between each index and axillary metastatic lymph nodes was analyzed by univariate correlation analysis. Results the results of conventional ultrasonography showed that 75.0% of the metastatic lymph nodes L / S < 2% and 18.1% of the non-metastatic lymph nodes L / S < 2% P < 0.01%. The cortical thickening type and the cortical stenosis type of lymph nodes were found in 75.0% of the metastatic lymph nodes and 18.1% of the non-metastatic lymph nodes. The percentage of lymphatic hilar type in metastasis group was 72.5% and 17.70.The benign group accounted for 22.67.4% and 0%, respectively (P < 0.01). The lymph nodes showed peripheral blood flow distribution in metastasis group (70.6%) and benign group (12.9%) (P < 0.01). There was no significant difference in RI between the two groups (P > 0.05). The proportion of non-uniform enhancement of lymph nodes was 82.4%, while that of benign lymph nodes was only 3.2% (P < 0.01). The sensitivity, specificity and accuracy of conventional ultrasonography in the diagnosis of benign and malignant axillary lymph nodes were 78.4% and 76.80.The sensitivity, specificity and accuracy of contrast-enhanced ultrasonography in the diagnosis of benign and malignant axillary lymph nodes were 90.3% and 90.2%, respectively. There was a significant difference between the two groups (P < 0.05). The results of correlation analysis showed that the maximum diameter of primary breast cancer was more than 2 cm, the length of lymph node was less than 2, and there was a correlation between the two groups and axillary lymph node metastasis of breast cancer (P < 0.05). Conclusion. 1. Contrast-enhanced ultrasonography is superior to conventional ultrasonography in the diagnosis of benign and malignant axillary lymph nodes in breast cancer. 2. There was a high risk of axillary lymph node metastasis in the patients with the maximum diameter 鈮

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