经皮内超声造影对乳腺癌前哨淋巴结的诊断价值

发布时间：2018-02-10 02:47

  本文关键词： 前哨淋巴结 超声造影 增强模式 乳腺癌 前哨淋巴结 前哨淋巴结活检 超声造影 细针穿刺活检 乳腺癌　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的乳腺癌术前超声造影定位腋窝前哨淋巴结,并探索增强模式对前哨淋巴结转移的预测价值。方法研究共入组组织学诊断为乳腺癌且常规超声诊断无淋巴结转移的患者110例。经乳晕边缘皮下注射超声造影剂Sonovue,追踪显影淋巴管至SLNs并定位,观察SLNs增强模式,手术采用蓝染法及吲哚菁绿定位前哨淋巴结。以手术及手术病理结果为金标准,判断超声造影定位SLN的准确性,及造影模式对淋巴结转移的诊断准确性。结果110例患者中,106例患者在术前超声造影发现增强134个SLNs,定位成功率达96.4%。其中,Ⅰ型增强模式(均匀增强)51个,经病理证实均为良性淋巴结;Ⅱ型增强模式(不均匀增强)76个,29个转移性淋巴结,47个良性淋巴结;Ⅲ型增强模式(无增强)7个,均为转移性淋巴结。将Ⅰ型增强模式判定为良性淋巴结,Ⅱ、Ⅲ型增强模式判定为转移性淋巴结,超声造影增强模式诊断SLNs的敏感度100%,特异度52.0%,阳性预测值43.4%,阴性预测值100%,准确率64.9%。结论乳腺癌术前超声造影可准确定位腋窝SLNs,Ⅰ型增强模式对SLNs阴性预测价值高;Ⅲ型增强模式对SLNs阳性预测价值高;不均匀增强的SLNs良恶性重叠度高,仅靠造影增强模式无法准确预测淋巴结状态。目的探索腋窝前哨淋巴结超声造影结合细针穿刺活检(FNA)对乳腺癌患者前哨淋巴结转移的诊断价值。方法研究共入组63例组织学诊断为乳腺癌且常规超声诊断无淋巴结转移的患者,经乳晕边缘皮下注射超声造影剂Sonovue,追踪显影淋巴管至SLNs并定位,观察SLNs增强模式,并对前哨淋巴结细针穿刺活检送病理。手术采用蓝染法及吲哚菁绿定位前哨淋巴结。以手术及手术病理结果为金标准,判定超声造影结合FNA对淋巴结转移的准确性。结果63例患者中,60例患者成功行超声造影发现73个前哨淋巴结。Ⅰ型增强模式(均匀增强)25例,FNA结果23例SLNs阴性,2例SLNs可疑阳性,手术病理均为阴性淋巴结;Ⅱ型增强模式(不均匀增强)42例,15例SLNs FNA及手术病理阳性,27例SLNs FNA阴性,其中6例手术病理阳性;Ⅲ型增强模式(无或弱增强)6例,FNA及手术病理均为阳性淋巴结。超声造影结合FNA预测前哨淋巴结转移的敏感度71.4%,特异度100%,阳性预测值100%,阴性预测值89.7%,准确度91.8%。结论超声造影结合细针穿刺活检可在术前较准确地评估乳腺癌患者前哨淋巴结转移的风险。这一方法将来有望应用于临床。
[Abstract]:Objective to locate axillary sentinel lymph nodes by contrast-enhanced ultrasonography before breast cancer. To explore the predictive value of enhancement model for sentinel lymph node metastasis. Methods 110 patients with breast cancer diagnosed by histologically and conventional ultrasound without lymph node metastasis were studied. Subcutaneous injection of ultrasound contrast agent via the edge of areola was performed in 110 patients without lymph node metastasis. Sonovue, trace the developed lymphatic vessels to SLNs and locate, To observe the enhancement mode of SLNs, blue staining and indocyanine green were used to locate the sentinel lymph nodes, and the accuracy of SLN localization by contrast-enhanced ultrasonography was evaluated according to the results of operation and pathology as gold standard. Results the enhancement of 134 SLNs was found in 106 out of 110 patients with lymph node metastasis, and the localization success rate was 96.44.Among them, 51 were type 鈪，

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