超声联合腋窝淋巴结穿刺的假阴性分析

发布时间：2018-05-13 15:25

本文选题：超声 + 腋窝淋巴结　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:超声联合腋窝淋巴结穿刺已经成为术前临床腋窝淋巴结评估的重要手段,其结果影响患者后续治疗方案。在临床实践过程中,我们发现这一评估方式存在一定的假阴性,本文试图统计超声联合腋窝淋巴穿刺的敏感性,分析与探讨其假阴性原因。方法:回顾性收集2015年1月至2016年6月期间于浙江大学医学院附属第二医院肿瘤外科收治的440例患者,统计个人基本信息(姓名、性别、年龄、入院时间、病案号)以及住院病历资料,包括入院查体信息、术前超声结果、乳腺肿物及腋窝淋巴结穿刺病理及免疫组化结果、术后常规病理结果以及是否接受新辅助化疗。1)分别计算查体、超声、空心针穿刺活检及超声联合穿刺活检的敏感性、特异性;2)计算超声联合穿刺活检的假阴性,进行单因素及多因素回归分析假阴性原因。结果:本研究中查体的敏感性、特异性分别为19.7%、97.5%;超声检查的敏感性、特异性分别为42.6%、90.0%。CNB敏感性、特异性分别为87.2%、100%。AUSB的敏感性、特异性分别为40.2%、100%。根据单因素分析结果,淋巴结大小、ALN转移、组织学分级、ER、PR与超声联合淋巴结穿刺的假阴性有关。多因素分析结果显示,腋窝淋巴结转移个数与假阴性有关。结论:超声及超声联合腋窝淋巴结穿刺的敏感性与腋窝淋巴结转移程度相关。腋窝转移淋巴结为1-2枚是导致更易出现AUSB假阴性的特征。超声及AUSB使得一部分患者免于不必要的SLNB,尽管其存在一定假阴性,仍是腋窝评估分期的重要手段。
[Abstract]:Objective: ultrasound combined with axillary lymph node puncture has become an important method for preoperative evaluation of axillary lymph nodes. In the course of clinical practice, we found that there is a certain false-negative in this evaluation method. This paper attempts to analyze the sensitivity of ultrasound combined with axillary lymphoid puncture, and to analyze and discuss the reasons of false negative. Methods: from January 2015 to June 2016, 440 patients treated in tumor surgery, second affiliated Hospital of Zhejiang University Medical College, were retrospectively collected and their personal basic information (name, sex, age, time of admission to hospital) were analyzed. Medical record number) and the medical records of the hospital, including the information of the admission examination, the results of ultrasound before operation, the pathological and immunohistochemical findings of breast masses and axillary lymph nodes, The sensitivity of body examination, ultrasound, hollow needle biopsy and combined ultrasound biopsy were calculated by routine pathological results and whether or not neoadjuvant chemotherapy. Univariate and multivariate regression analysis were performed for false negative causes. Results: the sensitivity of physical examination in this study was 19.77.55.The sensitivity of ultrasonic examination was 42.6and 90.0.CNB, the specificity was 87.2 and 100.AUSB, respectively. According to the results of univariate analysis, lymph node size and ALN metastasis and histological grade ERPR were associated with false negative ultrasound combined with lymph node puncture. Multivariate analysis showed that the number of axillary lymph node metastasis was associated with false negative. Conclusion: the sensitivity of ultrasound and ultrasound combined with axillary lymph node puncture is related to the degree of axillary lymph node metastasis. Axillary lymph node metastasis of 1-2 is more likely to cause false negative AUSB characteristics. Ultrasound and AUSB can protect some patients from unnecessary SLNBs, although they are false-negative, they are still an important method in the evaluation of axillary staging.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.9

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