本文關鍵詞： 前哨淋巴結 超聲造影 增強模式 乳腺癌 前哨淋巴結 前哨淋巴結活檢 超聲造影 細針穿刺活檢 乳腺癌　出處：《北京協(xié)和醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的乳腺癌術前超聲造影定位腋窩前哨淋巴結,并探索增強模式對前哨淋巴結轉移的預測價值。方法研究共入組組織學診斷為乳腺癌且常規(guī)超聲診斷無淋巴結轉移的患者110例。經(jīng)乳暈邊緣皮下注射超聲造影劑Sonovue,追蹤顯影淋巴管至SLNs并定位,觀察SLNs增強模式,手術采用藍染法及吲哚菁綠定位前哨淋巴結。以手術及手術病理結果為金標準,判斷超聲造影定位SLN的準確性,及造影模式對淋巴結轉移的診斷準確性。結果110例患者中,106例患者在術前超聲造影發(fā)現(xiàn)增強134個SLNs,定位成功率達96.4%。其中,Ⅰ型增強模式(均勻增強)51個,經(jīng)病理證實均為良性淋巴結;Ⅱ型增強模式(不均勻增強)76個,29個轉移性淋巴結,47個良性淋巴結;Ⅲ型增強模式(無增強)7個,均為轉移性淋巴結。將Ⅰ型增強模式判定為良性淋巴結,Ⅱ、Ⅲ型增強模式判定為轉移性淋巴結,超聲造影增強模式診斷SLNs的敏感度100%,特異度52.0%,陽性預測值43.4%,陰性預測值100%,準確率64.9%。結論乳腺癌術前超聲造影可準確定位腋窩SLNs,Ⅰ型增強模式對SLNs陰性預測價值高;Ⅲ型增強模式對SLNs陽性預測價值高;不均勻增強的SLNs良惡性重疊度高,僅靠造影增強模式無法準確預測淋巴結狀態(tài)。目的探索腋窩前哨淋巴結超聲造影結合細針穿刺活檢(FNA)對乳腺癌患者前哨淋巴結轉移的診斷價值。方法研究共入組63例組織學診斷為乳腺癌且常規(guī)超聲診斷無淋巴結轉移的患者,經(jīng)乳暈邊緣皮下注射超聲造影劑Sonovue,追蹤顯影淋巴管至SLNs并定位,觀察SLNs增強模式,并對前哨淋巴結細針穿刺活檢送病理。手術采用藍染法及吲哚菁綠定位前哨淋巴結。以手術及手術病理結果為金標準,判定超聲造影結合FNA對淋巴結轉移的準確性。結果63例患者中,60例患者成功行超聲造影發(fā)現(xiàn)73個前哨淋巴結。Ⅰ型增強模式(均勻增強)25例,FNA結果23例SLNs陰性,2例SLNs可疑陽性,手術病理均為陰性淋巴結;Ⅱ型增強模式(不均勻增強)42例,15例SLNs FNA及手術病理陽性,27例SLNs FNA陰性,其中6例手術病理陽性;Ⅲ型增強模式(無或弱增強)6例,FNA及手術病理均為陽性淋巴結。超聲造影結合FNA預測前哨淋巴結轉移的敏感度71.4%,特異度100%,陽性預測值100%,陰性預測值89.7%,準確度91.8%。結論超聲造影結合細針穿刺活檢可在術前較準確地評估乳腺癌患者前哨淋巴結轉移的風險。這一方法將來有望應用于臨床。
[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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