超声造影及其引导下导丝定位对乳腺癌前哨淋巴结的应用研究

发布时间：2018-03-17 21:42

本文选题：超声造影　切入点：乳腺癌　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨超声造影成像技术对乳腺癌前哨淋巴结检出及其引导下导丝定位的应用价值。方法:收集2016年3月~12月在山西医科大学附属肿瘤医院就诊的72例女性经病理诊断为乳腺癌的患者。第一步,常规扫查患侧乳房及同侧腋窝区淋巴结,对可疑淋巴结进行大小、皮质厚度测量及体表标记;第二步,术前1小时左右经乳晕缘皮下及原肿块切缘周围1cm的位置注射超声造影剂进行前哨淋巴结的显影检查,记录其造影增强特征(增强特征分为三型:第一型,显著均匀增强;第二型,不均匀增强,内含低增强或无增强区;第三型,微弱或不增强。)及其与常规扫查下的可疑淋巴结的对应性;第三步,针对造影追踪到的前哨淋巴结测量其皮质厚度以及进行超声引导下导丝定位;第四步,前哨淋巴结导丝定位后即行经乳晕缘皮下注射纳米炭混悬液染色。术中切除黑染的淋巴结及导丝定位的淋巴结并分别送病理检查。结果:1.依手术病理结果,72例乳腺癌患者一共摘除206枚前哨淋巴结。超声造影导丝定位的前哨淋巴结数目比纳米炭染色的少(83vs123)。超声造影导丝定位前哨淋巴结发生转移的阳性率为50.6%(42/83),比纳米炭染色法的阳性率(32.5%,40/123)高(c2=6.763,P=0.009,0.05)。2.83枚导丝定位的前哨淋巴结中,转移性淋巴结的皮质不均匀增厚,多见于皮质厚≥3.0mm(41/42)。3.前哨淋巴结造影增强的三型中,非转移性前哨淋巴结最多见于第一型(35/39),转移性前哨淋巴结常见于后两型(37/42)。结论:1.超声造影对乳腺癌腋窝前哨淋巴结有较高的敏感性。2.常规超声联合超声造影检查有望成为无创评价乳腺癌前哨淋巴结状态的重要诊疗手段。3.淋巴结皮质厚度对术前判断乳腺癌淋巴结是否转移具有重要价值。
[Abstract]:Objective: to evaluate the value of contrast-enhanced ultrasound in detecting sentinel lymph nodes of breast cancer and guiding the localization of guiding wire. Methods: from March 2016 to December, 72 women who were admitted to the affiliated Cancer Hospital of Shanxi Medical University were collected. Patients with pathologically diagnosed breast cancer. First step, Routine scanning of the breast and axillary lymph nodes on the ipsilateral side, the size of the suspected lymph nodes, the thickness of the cortex and body surface marking; the second step, Sentinel lymph nodes were examined with ultrasound contrast media 1 hour before operation by subcutaneous injection of mammary areola and 1 cm around the cutting margin of the original mass. The enhanced features of the sentinel lymph nodes were recorded (the enhancement features were divided into three types: type 1, significantly homogeneous enhancement; Type II, uneven enhancement, containing low or no enhancement areas; type III, weak or non-enhanced.) and its correspondence to suspicious lymph nodes under conventional scanning; step 3, For sentinel lymph nodes tracked by angiography, the cortical thickness was measured and guided by ultrasound to locate the guiding wire; 4th steps, The sentinel lymph nodes were treated with nano-carbon suspension staining by subcutaneous injection of nano-carbon suspension through the areola margin immediately after the orientation of the sentinel lymph nodes. The black stained lymph nodes and the guided filament-localized lymph nodes were removed during the operation and sent to pathological examination respectively. Results: 1. According to the results of surgery and pathology, 72 cases of mammary gland were removed. A total of 206 sentinel lymph nodes were removed in patients with adenocarcinoma. The number of sentinel lymph nodes located by the guide wire of contrast-enhanced ultrasound was 83vs123% less than that of carbon nanoparticles. The positive rate of metastasis of the sentinel lymph nodes was 50.642 / 83%, which was higher than that of carbon nanocrystalline staining. The positive rate of this method was 32.5% and 40 / 12 3) in the sentinel lymph nodes located by the guiding wire, the positive rate was 32.5%, and the number of sentinel lymph nodes (SLN) was high (C26.763) in 0.009 / 0.05 / 2.83 sentinel lymph nodes. Heterogeneous thickening of the cortex of metastatic lymph nodes was found in the three types of Sentinel lymph Node enhanced by Sentinel lymph Node contrast enhanced Sentinel lymph Node (Sentinel lymph Node). Non-metastatic sentinel lymph nodes were most commonly seen in type I 35 / 39, and metastatic sentinel lymph nodes were more common in the latter two types of lymph nodes than in the latter two types. Conclusion 1. Contrast-enhanced ultrasonography has a high sensitivity to axillary sentinel lymph nodes of breast cancer .2.Conventionally contrast-enhanced ultrasonography combined with contrast-enhanced ultrasonography is more sensitive to axillary sentinel lymph nodes in breast cancer. It is expected to be an important noninvasive method for the diagnosis and treatment of sentinel lymph node status in breast cancer .3.The thickness of lymph node cortex is of great value in determining the lymph node metastasis of breast cancer before operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R445.1

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