经皮内注射CEUS联合常规超声对乳腺癌前哨淋巴结诊断价值

发布时间：2018-05-08 11:06

本文选题：乳腺癌 + 前哨淋巴结　；参考：《广州中医药大学》2014年硕士论文

【摘要】：目的：评估常规超声(Conventional Ultrasound, US, B型超声+彩色多普勒超声)、经皮内注射超声造影(Contrast Enhanced Ultrasound, CEUS)联合常规超声对乳腺癌前哨淋巴结(Sentinel Lymph Node, SLN)的诊断价值。方法：对42例乳腺癌患者进行常规超声检查,了解乳腺肿块及腋窝淋巴结情况,然后于乳晕旁经皮内注射超声造影剂SonoVue后对引流淋巴管及SLN进行观察分析,CEUS检出显影SLN后,切换至基波模式以常规超声方法观察SLN。42例乳腺癌患者的SLN的常规超声及CEUS联合常规超声的诊断结果,均用五级评分法(1级,无转移；2级,可能无转移；3级,不确定；4级,可能转移；5级,转移)记录,并将两者结果进行比较。应用三级评分(0,无增益,1,轻度增益,2,显著增益)分析CEUS联合常规超声较常规超声的诊断改变。最后以病理结果作为金标准,比较常规超声、CEUS和两者联合诊断乳腺癌SLN的准确性、敏感性、特异性。应用ROC曲线分析常规超声、CEUS和两者联合对乳腺癌SLN的诊断价值。结果： 1.SLN的病理结果：42例乳腺癌患者SLN无转移24例,有转移18例。采用CEUS检测42例患者SLN,其中29例患者共检出34个SLN,无转移23个,有转移11个；其余13例患者未检出SLN,有转移8例,无转移5例。在超声造影检查基础上,采用常规超声检测42例患者SLN,其中38例患者共检出43个SLN,无转移25个,有转移18个；其余4例患者常规超声未检出SLN,3例无转移,1例有转移。 2.SLN的超声造影结果：42例患者,13例患者未检出SLN,其余29例患者共检出34个SLN,其中24例检出1个SLN,5例检出2个SLN,SLN检出率72.3%(34/47)。根据SLN病理结果分为转移组和无转移组,转移组和无转移组SLN的增强模式差异有统计学意义(P0.05),转移组多呈部分增强或不增强,无转移组多呈均匀增强。转移组和无转移组的SLN横径、前后径、垂直径、形态、淋巴管显影时间、造影检查所用时间、造影剂剂量之间差异均无统计学意义(PO.05)。 3.SLN的常规超声结果：42例患者,4例患者未检出SLN,其余38例患者共检出43个SLN,其中33例检出1个SLN,5例检出2个SLN。转移组SLN前后径(7.83±2.40mm)大于无转移组(5.21±1.55mm),转移组长径/短径(1.90±0.66)小于无转移组(2.41±1.20),差异有统计学意义(P0.05)。转移组和无转移组的SLN皮髓质情况、血流分布情况差异有统计学意义(P0.05),转移组多呈皮髓质分界不清或皮质局部增厚,多呈非淋巴门型血流；无转移组多呈皮髓质厚薄均匀,多呈淋巴门型血流。转移组和无移组的SLN横径、垂直径、形态、淋巴门情况差异无统计学意义(PO.05)。 4.转移组和无转移组的乳腺肿块位置、横径、前后径、垂直径、彩色多普勒血流、血流阻力指数、病理类型、孕激素受体(PR)、雌激素受体(ER)、HER-2之间差异均无统计学意义(PO.05)。 5.常规超声、CEUS和两者联合应用诊断乳腺癌SLN的准确性、敏感性、特异性分别为61.2%、36.8%、78.6%,72.3%、57.9%、82.1%和83.0%、63.1%、96.4%,常规超声和两者联合应用之间的差异有统计学意义(P0.05),CEUS和两者联合应用之间的差异无统计学意义(P0.05),CEUS和常规超声之间的差异无统计学意义(P0.05)。 6.常规超声、CEUS和两者联合应用诊断乳腺癌SLN的ROC曲线下面积(Area underthe curve,AUC)分别为0.70、0.72、0.89,常规超声和CEUS联合常规超声的AUC差异有统计学意义(P0.05),CUES和CEUS联合常规超声的AUC差异有统计学意义(P0.05),CUES和常规超声的AUC差异无统计学意义(P0.05)。 7.与常规超声对比,CEUS联合常规超声对乳腺癌SLN有48.9%(23/47)的诊断增益。与常规超声对比,CEUS联合常规超声对不同位置、不同病理类型、不同肿块大小、不同分子亚型乳腺癌的SLN,均有诊断增益,但差异均无统计学意义(P0.05)。结论： 1.CEUS联合常规超声诊断乳腺癌SLN的准确性、敏感性、特异性及ROC曲线下面积大于两种方法单独应用。 2.与常规超声对比,CEUS联合常规超声对乳腺癌的SLN有诊断增益,提高诊断信心。
[Abstract]:Objective:
To evaluate the diagnostic value of conventional ultrasound (Conventional Ultrasound, US, B ultrasound + color Doppler ultrasound), percutaneous intradermal ultrasound (Contrast Enhanced Ultrasound, CEUS) combined with conventional ultrasound in the diagnosis of sentinel lymph node (Sentinel Lymph Node, SLN) in breast cancer.
42 cases of breast cancer were examined by routine ultrasonography to understand the breast lumps and axillary lymph nodes. Then the drainage lymphatic vessels and SLN were observed and analyzed after the intradermal injection of ultrasound contrast agent SonoVue. After CEUS detected the developing SLN, the normal ultrasonic method was used to observe the SLN of the breast cancer patients in SLN.42 cases. The diagnostic results of conventional ultrasound and CEUS combined with conventional ultrasound were measured by the five grade score (Level 1, no transfer, grade 2, no transfer, 3, undetermined, 4, possible transfer, 5, transfer), and compared the results. The application of the three grade score (0, no gain, 1, mild gain, 2, significant gain) analysis of CEUS combined conventional ultrasound was more conventional. Diagnostic changes of ultrasound. Finally, the diagnostic value, sensitivity and specificity of conventional ultrasound, CEUS and combined diagnosis of breast cancer SLN were compared with the pathological results as the gold standard. The diagnostic value of conventional ultrasound, CEUS and the combination of both CEUS and the combination of CEUS and both on the diagnosis of breast cancer SLN.
The pathological results of 1.SLN: 24 cases without metastasis and 18 cases of metastasis in 42 cases of breast cancer. 42 patients with SLN were detected by CEUS. 34 SLN was detected in 29 cases, 23 were transferred without metastasis and 11 in the other 13 cases, 8 cases and 5 metastases were not detected in the other 13 patients. On the basis of ultrasound contrast examination, routine ultrasonography was used to detect 42 patients S. LN, of which 38 patients were detected 43 SLN, 25 without metastasis, 18 with metastasis, the remaining 4 patients were not detected by conventional ultrasound SLN, 3 cases without metastasis, 1 cases of metastasis.
2.SLN ultrasound contrast results: 42 patients, 13 cases were not detected SLN, the other 29 cases were detected 34 SLN, of which 24 cases detected 1 SLN, 5 cases were 2 SLN, SLN detection rate 72.3% (34/47). According to SLN pathological results were divided into the transfer group and no metastasis group, the difference of the enhancement pattern of SLN in the transfer group and the non transfer group was statistically significant (P0.05), the difference was statistically significant (P0.05). The migration group was mostly enhanced or not enhanced, and the non metastasis group was more homogeneous. The SLN transverse diameter, the front and back diameter, the vertical diameter, the shape, the time of lymphatic development and the time used in the contrast examination were not statistically significant (PO.05).
3.SLN routine ultrasound results: 42 patients, 4 cases were not detected SLN, the other 38 cases were detected 43 SLN, of which 33 cases detected 1 SLN, 5 cases were detected in 2 SLN. metastasis group (7.83 + 2.40mm) larger than no metastasis group (5.21 + 1.55mm), the metastasis group length / short diameter (1.90 + 0.66) was less than no metastasis group (2.41 + 1.20), the difference was statistically significant. (P0.05) the distribution of the blood flow in the SLN medulla in the transfer group and the non transfer group had a significant difference (P0.05). The metastasis group was mostly the demarcation of the medulla and the partial thickening of the cortex, most of the non lymphatic portal blood flow; the non metastasis group was most of the skin and medulla thick and thin, most of the lymphatic portal blood flow. The SLN transverse diameter of the transfer group and the non shift group was vertical, vertical. There was no significant difference in diameter, morphology and lymphatic status (PO.05).
4. the location of breast mass, transverse diameter, anterior and posterior diameter, vertical diameter, color Doppler blood flow, blood flow resistance index, pathological type, progesterone receptor (PR), estrogen receptor (ER), and HER-2 were not statistically significant (PO.05).
5. the accuracy of diagnosis of breast cancer SLN with conventional ultrasound, CEUS and the combination of the two, sensitivity, specificity were 61.2%, 36.8%, 78.6%, 72.3%, 57.9%, 82.1% and 83%, 63.1%, 96.4%, and the difference between the conventional ultrasound and the combination of the two was statistically significant (P0.05), and the difference between CEUS and the combination of the two was not statistically significant (P0.05), CEUS There was no significant difference between conventional ultrasound and conventional ultrasound (P0.05).
6. the area under the ROC curve (Area underthe curve, AUC) for the diagnosis of breast cancer SLN (AUC) was 0.70,0.72,0.89. The difference between conventional ultrasound and CEUS combined with conventional ultrasound was statistically significant (P0.05). There was a significant difference between the conventional ultrasound and conventional ultrasound (P0.05). 6. There was no statistical significance (P0.05).
7. compared with conventional ultrasound, CEUS combined with conventional ultrasound had 48.9% (23/47) diagnostic gain for SLN of breast cancer. Compared with conventional ultrasound, CEUS combined with conventional ultrasound had diagnostic benefits for different locations, different pathological types, different mass sizes, and SLN of different molecular subtypes of breast cancer, but the difference was not statistically significant (P0.05).
The accuracy, sensitivity, specificity and the area under the ROC curve of 1.CEUS combined with conventional ultrasound in the diagnosis of breast cancer SLN were greater than two methods alone.
2. compared with conventional ultrasound, CEUS combined with conventional ultrasound has a diagnostic gain for breast cancer SLN and improves diagnostic confidence.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R737.9

【参考文献】