超声在判断临床触诊阴性乳腺癌前哨淋巴结转移的诊断价值

发布时间：2018-05-30 09:03

本文选题：乳腺癌 + 超声　；参考：《中国人民解放军军事医学科学院》2015年硕士论文

【摘要】：研究背景：乳腺癌是女性最常见的恶性肿瘤。随着研究的逐步深入,乳腺癌的治疗已进入到了个体化综合治疗时代。乳腺癌的外科手术治疗更是由最早的Halsted术式向现代微创治疗转变,即由最大的可耐受切除,转变到现在的最小有效治疗。目前,前哨淋巴结活检(Sentinel lymph node biopsy, SLNB)已经替代腋窝淋巴结的清扫(completion axillary lymph node dissection CALND)成为早期乳腺癌腋窝林巴结(Axillary lymph node, ALN)分期的金标准。对于临床触诊阴性的患者,SLN的转移率较低,SLN作为一种有创检查会产生一些术后并发症,与ALN转移旧关的因素已经基本明确,而对于与SLN转移相关的因素还不十分明确。目的：回顾性分析临床检查ALN阴性乳腺癌患者ALN的转移状态。找出与ALN及SLN转移相关的因素。方法：收集2009年1月至2013年1月我院初治临床触诊阴性乳腺癌并行SLNB的患者357例,SLN转移阳性患者行腋窝淋巴结清扫(Axillary lymph node dissection, ALND)。分析肿瘤T分期、分子分型与ALN及SLN转移的相关性,术前B超判断乳腺癌SLN转移的诊断价值。结果：临床ALN触诊阴性乳腺癌患者,SLN总体转移率21.0%(75/357)；T1与T2期SLN转移率分别为20.6%、23.7%, T分期与SLN转移率无关,P=0.54；uminal A-like型,Luminal B-like (HER2-)型,Luminal B-like (HER2+)型,HER2过表达型,三阴型SLN转移率分别为35.0%,17.6%,25.6%,22.2%,14.3%,SLN的转移与肿瘤分子分型无关,P=0.14；B超判断ALN转移与实际SLN转移的总体符合率为68.6%(245/357)；敏感性为44.0%(33/75),特异性为75.2%(212/282),阳性预测值为32.0%(33/103),阴性预测值为83.5%(212/254)假阴性率为16.5%(42/254)。当SLN转移阳性,B超判断ALN转移阳性患者的非SLN转移率明显高于B超判断转移阴性患者,非SLN转移率分别为72.7%(16/22)、14.3%(6/42),p0.05；B超判断ALN转移阴性患者非SLN淋巴结转移负荷较低,均未超过2枚。结论：ALN临床阴性乳腺癌患者的ALN转移率较低,其转移率与肿瘤T分期、分子分型无关；B超可以较准确判断ALN的转移状态；B超判断ALN转移阴性实际转移阳性患者仅有较低的淋巴结转移负荷。
[Abstract]:Background: breast cancer is the most common malignant tumor in women. With the development of research, the treatment of breast cancer has entered the era of individualized comprehensive therapy. The surgical treatment of breast cancer has changed from the earliest Halsted operation to the modern minimally invasive treatment, that is, from the largest tolerable resection to the present minimal effective treatment. At present, sentinel lymph node biopsy, SLNB) (Sentinel lymph node biopsy, SLNB) has replaced axillary lymph node dissection (axillary lymph node dissection CALND) as the gold standard for axillary lymph node, ALN) staging in early breast cancer. For the patients with negative palpation, the metastasis rate of SLN is lower. As a invasive examination, SLN will produce some postoperative complications, and the factors related to ALN metastasis have been basically clear, but the factors related to SLN metastasis are not very clear. Objective: to retrospectively analyze the metastatic status of ALN in patients with ALN negative breast cancer. Find out the factors related to ALN and SLN metastasis. Methods: from January 2009 to January 2013, 357 patients with primary palpation negative breast cancer combined with SLNB were examined by axillary lymph node dissection, Aldd. The correlation between T stage, molecular classification and ALN and SLN metastasis was analyzed. The diagnostic value of SLN metastasis in breast cancer was evaluated by B-ultrasound before operation. Results: the overall metastatic rate of SLN in clinical ALN palpation negative breast cancer patients was 21.0% 75 / 357T 1 and 23.7%, respectively. The T stage was not related to the SLN metastasis rate. There was no correlation between T stage and SLN metastasis rate. There was no significant difference between T stage and SLN metastasis rate. The metastatic rates of SLN of the three negative type were 35.0 / 17.6 / 25.62and 22.2and 14.3N, respectively. There was no correlation between the metastasis of ALN and the molecular typing of the tumor. The overall coincidence rate of B-mode ultrasound in judging the metastasis of ALN and the actual metastasis of SLN was 68.6%. The sensitivity was 44.075%, the specificity was 75.21212282%, the positive predictive value was 32.033 / 103, and the negative predictive value was 83.521212 / 254) the false rate was 16.522544% (P = 16.52254N), and the negative predictive value was 83.521212% 2544.The false rate was 16.522540.The sensitivity was 44.075%, the specificity was 75.212282n, the positive predictive value was 32.033 / 103n, and the negative predictive value was 83.521212 / 254). When SLN metastasis was positive, the non-SLN metastasis rate of patients with positive ALN metastasis by B-ultrasound was significantly higher than that with negative metastasis by B-mode ultrasound. The non-SLN metastasis rate was 72.7 / 22 / 14.3%, respectively, and the load of non-SLN lymph node metastasis in ALN metastasis negative patients was lower than that of non-SLN lymph node metastasis. Conclusion the ALN metastasis rate of the patients with clinical negative breast cancer is lower, and the metastasis rate and T stage of the tumor are lower. Molecular typing was not significant; B-mode ultrasound could accurately judge the metastatic status of ALN; B-mode ultrasound could judge the metastatic status of ALN negative patients with actual metastasis only had lower lymph node metastasis load.
【学位授予单位】：中国人民解放军军事医学科学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

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