恶性淋巴瘤受累淋巴结的全身螺旋计算机层析成像表现

目的探讨恶性淋巴瘤累及淋巴结的全身螺旋计算机层析成像（CT）表现及其解剖分布。方法回顾性分析89例诊治的淋巴瘤患者,其中霍奇金淋巴瘤（HL）12例,非霍奇金淋巴瘤（NHL）77例。所有患者均行颈部、胸部及全腹部CT直接增强扫描,记录所有病例肿大淋巴结分布、大小、密度及强化程度。结果HL组患者中普遍均匀强化9例（75．0％）,均匀强化伴坏死3例（25．0％）;NHL组中普遍均匀强化64例（83．1％）,均匀强化伴坏死13例（16．9％）,两组均匀强化情况比较差异无统计学意义（Fisher精确概率法,P=0．4461）。HL组中淋巴结呈融合状6例（50．0％）,不融合6例（50．0％）;NHL组中淋巴结呈融合状8例（10．4％）,不融合69例（89．6％）,两组比较差异有统计学意义（Fisher精确概率法,P=0．0028）。HL组患者常优势累及颈部及纵隔淋巴结,NHL组患者常优势累及颈部、纵隔及腹腔淋巴结,两组全身淋巴结累及优势分布差异无统计学意义（Fisher精确概率法,P=0．110）。结论全身螺旋CT扫描能很好的显示淋巴瘤患者全身淋巴结肿大的形态、部位及分布。     

腹部转移性淋巴结与非霍奇金淋巴瘤淋巴结的比较分析——螺旋CT评估

目的通过螺旋CT扫描探讨腹部转移性淋巴结与非霍奇金淋巴瘤淋巴结的CT表现及其鉴别诊断。方法回顾性分析腹部淋巴结转移和非霍奇金淋巴结淋巴瘤各30例，测定平扫淋巴结的CT值，记录淋巴结分布区域和强化模式，然后进行统计学分析。入选淋巴结的标准是短径≥1．0cm，CT值测定方法是选取整个淋巴结为感兴趣区域（ROI），每个病例任意选取1～2个淋巴结测定。结果平扫CT值，腹部非霍奇金淋巴瘤与淋巴结转移瘤比较差异有显著性（t=7．216，P〈0．01），前者的均值为（40．15±4．29）HU，后者的均值为（32．53±5．19）HU；强化模式比较，两者在周边强化方面差异有显著性，转移性淋巴结周边强化明显多于淋巴瘤淋巴结。转移性淋巴结40．0％（12／30）为周边强化；非霍奇金淋巴瘤淋巴结（本组均为未治）10．0％（3／30）周边强化。优势分布区域方面，转移性淋巴结优势分布于腹主动脉上区、小网膜、肠系膜及肾旁前间隙；非霍奇金淋巴瘤淋巴结主要分布于腹主动脉上下区、肠系膜区、肾旁前间隙以及小网膜区域。两者在腹主动脉下区分布比较差异有显著性（P=48．654，P〈0．01），非霍奇金淋巴瘤淋巴结在该区分布明显多于肿瘤转移性淋巴结。结论利用螺旋CT分别从淋巴结的CT值、强化模式及优势分布区域等方面可以总结出腹部转移性淋巴结和非霍奇金淋巴瘤淋巴结的征象，并对两者作出一定的鉴别诊断。     

淋巴瘤侵犯腹部和盆腔淋巴结的少见CT表现:环形强化

目的分析淋巴瘤侵犯腹部和盆腔淋巴结呈环形强化的CT表现,认识其较为少见的CT表现特点,提高诊断水平。方法回顾性分析14例经组织学证实的淋巴瘤侵犯腹部和(或)盆腔淋巴结在增强CT呈环形强化的影像特点,观察受累淋巴结的解剖分布、大小、形态及密度。其中非霍奇金淋巴瘤(NHL)12例,霍奇金淋巴瘤(HL)2例。结果呈环形强化的淋巴结依次分布在肾门上、下部腹膜后区(n=8),髂血管周围(n=8),腹腔(n=6)及肠系膜(n=3)。环形强化淋巴结的短径2~10cm(平均4.2cm)。9例淋巴结完全融合或融合为主,5例淋巴结孤立或孤立为主。13例同时有其他均匀强化的淋巴结,仅1例淋巴结全部为环形强化。11例强化环的形态规则、厚度基本一致,3例不规则、薄厚不一。13例强化环的密度高于肌肉,1例等于肌肉。11例中心低密度区的密度均匀,低于肌肉;3例内部密度不均,低于与等于肌肉密度区并存。结论淋巴瘤侵犯腹部和盆腔淋巴结呈环形强化时主要分布在肾门上、下部腹膜后区、髂血管周围、腹腔及肠系膜,常与均匀强化的淋巴结并存,以完全融合或融合为主,强化环形态规则且密度多高于肌肉,中心低密度区的密度多均匀且低于肌肉。     

非霍奇金淋巴瘤中侵袭性淋巴瘤和惰性淋巴瘤的18F-FDG PET/CT显像特征

目的:分析非霍奇金淋巴瘤（non-Hodgkin's lymphoma,NHL）中侵袭性淋巴瘤和惰性淋巴瘤的临床病理参数和18F-FDG PET/CT代谢参数的差异,探讨18F-FDG PET/CT代谢参数对预测侵袭性和惰性淋巴瘤的价值。方法:回顾性分析2011年9月至2016年12月于哈尔滨医科大学附属肿瘤医院行18F-FDG PET/CT检查的66例淋巴瘤患者,记录患者的年龄、性别、是否发热、浅表及深部淋巴结受侵、结外侵犯、临床分期及PET/CT代谢参数［包括:最大标准化摄取值（maximum standardized uptake value,SUVmax）、肿瘤/纵隔血池比值（tumor SUVmax value/mediastinal SUVmax value,T/MB）、总糖酵解量（total lesion glycolysis,TLG）、肿瘤代谢体积（metabolic tumor volume,MTV）］,分析以上各因素在侵袭性淋巴瘤与惰性淋巴瘤之间的差异,绘制PET/CT代谢参数诊断侵袭性淋巴瘤和惰性淋巴瘤的ROC曲线,并计算诊断效能。结果:侵袭性淋巴瘤和惰性淋巴瘤的年龄、性别、发热、浅表淋巴结侵犯、临床分期无统计学差异（P>0.05）,而二者的深部淋巴结侵犯、结外受侵存在统计学差异（P<0.05）。侵袭性淋巴瘤的SUVmax、T/MB、TLG较惰性淋巴瘤高（P<0.05）。ROC曲线统计结果表明,SUVmax、T/MB、TLG分别以11.49、3.45、29.44为截断点时诊断侵袭性和惰性淋巴瘤的效能最佳,灵敏度分别为75%、80.4%、67.9%;特异度分别为90%、90%、70%。结论:侵袭性淋巴瘤的SUVmax、T/MB和TLG显著高于惰性淋巴瘤,在分析诊断淋巴瘤侵袭性时,18F-FDG PET/CT各参数具有重要参考价值,可为临床决策提供依据。     

淋巴瘤累及横结肠系膜的螺旋CT特征及其解剖学基础

目的探讨非霍奇金淋巴瘤（NHL）累及横结肠系膜的多排螺旋CT表现特征。方法回顾性分析27例cT扫描资料和临床资料完整的NHL累及横结肠系膜的病例,均经病理证实。着重观察横结肠系膜病变的CT表现特征。结果横结肠系膜受累主要表现为系膜体部和系膜根部淋巴结受侵,横结肠系膜局灶性密度增高18例。系膜体部淋巴结增大25例,增大淋巴结均为均匀强化。系膜根部淋巴结增大27例,其中增大淋巴结均匀强化者24例（88．9％）,增大淋巴结均匀强化合并坏死者3例（11．1％）。系膜体部“三明治征”5例,系膜根部“三明治征”9例。结论多排螺旋CT可显示NHL累及横结肠系膜的解剖细节及淋巴结的某些大体病理改变。     

38例鼻咽癌腔外侵犯的CT扫描分析

（目的）分析鼻咽癌腔外侵犯的情况及其与颈部淋巴结转移的关系。（方法）总结38例经活检病理证实为鼻咽癌患者的CT图像。平扫11例，平扫加增强27例，横断加冠状位扫描4例。层厚、层距各5mm。（结果）38例均有鼻咽腔变形、局部隆起、粘膜下增厚肿块、咽隐窝挤压、消失等变化。参照黎福祥的咽旁间隙划区方法，94．7％有不同程度咽旁间隙侵犯。咽旁间隙后区受侵者，颈淋巴结转移63．3％（19／30）。口咽受侵者，颈淋巴结转移率为100％（10／10）。受侵部位大于3个者，颈淋巴结转移率为86．6％（13／15）。（结论）CT扫描对鼻咽癌诊断及明确侵及部位具有重要价值。合理扫描可增加肿瘤侵及范围的检出率。咽旁后间隙受侵、口咽受侵及部位多者其颈淋巴结转移率高，这对放疗设野具有重要参考价值。     

腹膜转移瘤的螺旋CT与手术病理对照研究

目的 探讨螺旋CT（SCT）增强扫描对腹膜转移瘤的诊断价值。方法 经手术病理证实为腹膜转移瘤的患者38例,术前1周内行全腹CT平扫及SCT增强扫描。分析CT扫描所见,并与手术病理所见进行对照。结果 在SCT增强早期,大多数腹膜转移瘤表现出不同程度的强化;目测原发肿瘤与转移灶有相同程度的强化;对血供丰富的肿瘤,SCT增强扫描可显示2nm的种植灶。CT平扫及SCT增强扫描对腹膜转移瘤总的敏感性分别为46．7％和76．6％（P＜0．005）,对附件、膈下、小肠系膜、横结肠系膜与大网膜,SCT增强扫描对腹膜转移瘤的检出率＞83％。结论 SCT增强扫描诊断腹膜转移瘤优于CT平扫,是诊断腹膜转移瘤有效的影像检查方法。     

扩散性滤泡性淋巴瘤1例报告并文献复习

患者女性,60岁,于2007年12月无意问发现左下腹包块,至外院就诊腹部CT示肠系膜根部不规则软组织肿块,考虑淋巴瘤可能性大,腹膜后多个小淋巴结,遂行手术切除肠系膜根部肿块送病理检查,免疫组化：（空肠系膜）滤泡细胞L26（＋）、bcl-2（＋）、CD3（-）、eyelinD（-）,诊断为滤泡性淋巴瘤,1级。2008年1月查全身PET／CT示：腹腔及腹膜后多发病灶,代谢活跃,符合淋巴瘤,其他部位未见肿瘤。     

原发睾丸非霍奇金淋巴瘤26例临床分析

目的：探讨原发睾丸非霍奇金淋巴瘤(non-Hodgidn’s lymphoma,NHL)的临床特点、治疗方法。方法：收集我院1980年10月至2002年2月收治的睾丸NHL26例,Ann Arbor分期ⅠE期17例,ⅡE期6例,ⅣE期3例。全部手术治疗。首程术后化疗24例,以CHOP方案为主,3～6周期,化疗加放疗9例,其中对盆腔／腹主动脉旁／阴囊等区域进行预防性放疗7例,针对病灶区放疗2例。阴囊区用9～12M eV电子线,其余用6～8MV-X线照射。照射剂量范围在36～50Gy,预防照射的平均剂量为40Gy。单纯手术和手术加放疗各1例。结果：全组一、三、五年总体生存率和无进展生存率分别为96．0％、78．1％、52．0％和70．2％、55．3％、49．2％。总失败率为53．8％,其中对侧睾丸、中枢神经系统受侵率分别为15．4％、11．5％,腹膜后淋巴转移率19．2％。结论：睾丸NHL一般为中-高度恶性,结外器官和淋巴结受侵率高,睾丸和腹膜后区分别占结外器官和淋巴结受侵的首位。所有期别的睾丸NHL都应化疗。ⅠE、ⅡE期病例应常规行腹主动脉旁、同侧髂血管旁和阴囊区预防性照射。ⅢE、ⅣE期以化疗为主,残留病灶辅以局部放疗。     

B细胞性非霍奇金淋巴瘤中BCL-6、CD10和BCL-2的蛋白表达及其临床病理意义

背景与目的：BCL-6、CD10均为淋巴结生发中心B淋巴细胞（GC—B细胞）的标志，它们在结内外弥漫性大B细胞淋巴瘤（DLBCL）及其它类型淋巴瘤中的表达特征及意义值得研究。本研究分析了B细胞性非霍奇金淋巴瘤（B—NHL）中BCL-6、CD10和BCL-2的蛋白表达及其临床病理意义。方法：免疫组化EnVision两步法分析135例B—NHL常见类型[包括DLBCL 22例，滤泡性淋巴瘤（FL）18例，B小淋巴细胞性淋巴瘤（B—SLL）18例，套细胞淋巴瘤（MCL）15例，淋巴浆细胞性淋巴瘤（LPL）7例，Burkitt’s淋巴瘤（BL）5例，B淋巴母细胞性淋巴瘤（LBL）3例；结外DLBCL 29例，胃粘膜相关淋巴样组织结外边缘区B细胞淋巴瘤（MALT-L）18例]和对照组5例T—NHL、5例结节型淋巴细胞为主型霍奇金淋巴瘤（NLPHL）以及10例淋巴结反应性增生（RLH）石蜡包埋组织中BCL-6、CD10以及BCL-2蛋白的表达。结果：①BCL-6和CD10阳性表达均只见于RLH（100％和100％）、结内DLBCL（72．7％和40．9％）、结外DLBCL（75．9％和41.4％）、FL（88．9％和72．2％）以及BL（100％和100％），其余B—NHL如B-SLL、MCL、MALT—L、LPL、LBL以及T-NHL和NLPHL中均未见BCL-6和CD10蛋白的表达。BCL-2蛋白表达可见于结内、结外DLBCL、FL、B—SLL、MCL、MALT—L以及LBL，阳性率分别为：36．4％、27．6％、83．3％、88．9％、86．7％、72．7％和33．3％；而LPL、BL、T—NHL以及NLPHL未见BCL-2蛋白表达；②DLBCL中BCL-6的表达形式可以分为四种类型：GC／FL型、中间型、散在型和阴性型；③40．9％的结内DLBCL、41．4％的结外DLBCL、72．2％的FL以及100％的BL为BCL-6＋／CD10＋表达，其中BCL-6蛋白表达均为GC／FL型；④在临床特征上，BCL-6＋／CD10＋的结内DLBCL与非BCL-6＋／CD10＋的结内DLBCL相比，前者的临床分期低于后者（P〈0．05）。结论：BCL-6、CD10和BCL-2蛋白的联合检测，可以用于部分B—NHL的诊断和鉴别诊断；BCL-6＋／CD10＋的结内淋巴瘤可能具有更好的临床预后。     

Involvement of Abdominal and Pelvic Lymph Nodes in Non-Hodgkin Lymphoma： the Nodal Distribution in Chinese Patients

Objective To study the distribution of abdominal and pelvic lymphadenopathy in non-Hodgkin lymphoma (NHL) in Chinese patients. Methods CT images of 241 NHL patients with abdominal and/or pelvic lymphadenopathy were reviewed. Among them, clinical and image data from 96 patients fulfilled the requirements for the analysis: 1. Abdominal and/ or pelvic lymphadenopathy detected by CT in untreated patients (n=74). 2. Recurrent patients: new lesions in abdominal or pelvic lymph nodes who never had any nodular lesion by previous abdominal and/or pelvic CT (n = 14). 3. Treated patients who did not have abdominal and/or pelvic CT previously, showed regression of initial disease for at least 6 months after chemotherapy and subsequently showed abdominal and/or pelvic lymphadenopathy (n=8). According to the Clinical Schema for Lymphoid Tissue, these patients were divided into 3 histologic subtypes: indolent (IL; n=31), aggressive (AL; n=61) and very aggressive (VAL; n=2) lymphoma. The remaining 2 cases were unclassified lymphoma (UCL). Both abdominal and pelvic CT scans were undertaken in 46 patients, abdominal CT only in 47 patients and pelvic CT only in 3 patients. Enhanced CT was obtained in 80 patients. The anatomic sites involved were designated as retroperitoneal (ie. paraaortic), mesenteric, abdominal (i.e. celiac, paracardiac, gastrohepatic and hepatic hilum, etc.), retrocrural, subdiaphragmatic, common iliac, internal iliac, external iliac and inguinal nodes respectively. Results The lesions located in the retroperitoneum were most common for IL and AL, the incidences being 83.3% (18/25) and 83.1% (49/59) respectively, results being similar. Among those, lymphadenopathy distributed mainly in the retroperitoneum, superior and inferior renal hila, with an incidence of 72.0% (18/25) in IL and 67.3% (33/49) in AL. Pelvic lymphadenopathy came next, with the overall incidence of 41.9% (126/301), 57.5% (50/87) in IL and 35.5% (76/214) in AL respectively. Mesenteric lymph nodes stood third with the overall incidence of 37.1 % (33/89), 43.3% (13/30) in IL and 33.9% (20/59) in AL. Statistical analysis showed that external iliac lymph node involvement to be more common in IL than in AL (P<0.05), while comparisons of other groups showed no statistical significance. Conclusion For Chinese NHL patients, retroperitoneal lymph nodes were mostly involved, followed by iliac and mesenteric lymphadenopathy, which was different from that of the Western countries. The involved retroperitoneal lymph nodes in NHL of Chinese patients were predominantly located in the superior and inferior renal hilum.     

Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy

BACKGROUND: The incidence and distribution pattern of retroperitoneal lymph node metastasis in patients with cervical carcinoma should be investigated based on data from systematic pelvic lymph node (PLN) and paraaortic lymph node (PAN) dissection, so that a basis can be established for determining the site of selective lymph node dissection or sampling. METHODS: A total of 208 patients with Stages IB, IIA, and IIB cervical carcinoma who underwent radical hysterectomy and systematic pelvic and PAN dissection were investigated for lymph node metastasis and histopathologic risk factors for lymph node metastasis. RESULTS: Fifty-three patients (25.5%) had lymph node metastasis. The obturator lymph nodes were most frequently involved, with a rate of 18.8% (39/208). Forty-nine of 53 node-positive patients had lymph node metastasis in the obturator, internal iliac, or common iliac lymph nodes. Of 26 solitary lymph node metastases confined to one node group, 18 were in the obturator, 3 in the internal iliac, 3 in the parametrial, and 2 in the common iliac lymph nodes. A multiple logistic regression analysis revealed that deep cervical stromal invasion and lymph-vascular space invasion were related to PLN metastasis. It was also shown that metastasis to bilateral PLNs (excluding the common iliac lymph nodes) as well as metastasis to the common iliac lymph nodes were significantly related to PAN metastasis. CONCLUSIONS: The results of this study suggest that the obturator lymph nodes can be sentinel lymph nodes of cervical carcinoma. PAN metastasis appears to occur secondarily to wide-spread PLN metastasis. These results provide a basis for determining the site of selective lymph node dissection and for estimating the existence of PAN metastasis from the pattern of metastasis in PLN in patients with cervical carcinoma.     

Target volume definition in high-risk prostate cancer patients using sentinel node SPECT/CT and

ABSTRACT: BACKGROUND: To assess the influence of sentinel lymph nodes (SNs) SPECT/CT and 18F-choline (18F-FCH) PET/CT in radiotherapy (RT) treatment planning for prostate cancer patients with a high-risk for lymph node (LN) involvement. METHODS: Twenty high-risk prostate cancer patients underwent a pelvic SPECT acquisition following a transrectal ultrasound guided injection of 99mTc-Nanocoll into the prostate. In all patients but one an 18F-FCH PET/CT for RT treatment planning was performed. SPECT studies were coregistered with the respective abdominal CTs. Pelvic SNs localized on SPECT/CT and LN metastases detected by 18F-FCH PET/CT were compared to standard pelvic clinical target volumes (CTV). RESULTS: A total of 104 pelvic SNs were identified on SPECT/CT (mean 5.2 SNs/patient; range 1-10). Twenty-seven SNs were located outside the standard pelvic CTV, 17 in the proximal common iliac and retroperitoneal regions above S1, 9 in the pararectal fat and 1 in the inguinal region. SPECT/CT succeeded to optimize the definition of the CTV and treatment plans in 6/20 patients due to the presence of pararectal SNs located outside the standard treatment volume. 18F-FCH PET/CT identified abnormal tracer uptake in the iliac LN region in 2/19 patients. These abnormal LNs were negative on SPECT/CT suggesting a potential blockade of lymphatic drainage by metastatic LNs with a high tumour burden. CONCLUSIONS: Multimodality imaging which combines SPECT/CT prostate lymphoscintigraphy and 18F-FCH PET/CT identified SNs outside standard pelvic CTVs or highly suspicious pelvic LNs in 40% of high-risk prostate cancer patients, highlighting the potential impact of this approach in RT treatment planning.     

Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study

BACKGROUND: The objective of the current study was to determine the accuracy of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for detecting lymph node metastases in patients with uterine cervical carcinoma compared with thin-section histopathologic results from systemic lymphadenectomy. METHODS: Twenty-two patients with International Federation of Obstetrics and Gynecology (FIGO) Stage IB-IVA cervical carcinoma who underwent both MRI and PET/CT before lymphadenectomy were included in this study. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. To enable region-specific comparisons, paraaortic and pelvic lymph nodes were divided into seven regions: the paraaortic area, both common iliac areas, both external iliac areas, and both internal iliac/obturator areas. Histopathologic evaluation of lymph nodes was the diagnostic standard. Chi-square analysis was used to compare the accuracy of MRI and PET/CT for the detection of metastatic lymph nodes. A P value < or = 0.05 was considered statistically significant. RESULTS: With MRI, the sensitivity, specificity, and accuracy rates for detecting metastatic lymph nodes in each lymph node group were 30.3% (10 of 33 lymph node groups), 92.6% (112 of 121 lymph node groups), and 72.7% (122 of 154 lymph node groups), respectively; with PET/CT, those rates were 57.6% (19 of 33 lymph node groups), 92.6% (112 of 121 lymph node groups), and 85.1% (131 of 154 lymph node groups), respectively. Statistical analysis showed that PET/CT was more sensitive than MRI (P = 0.026) but that there were no statistical differences noted with regard to specificity (P = 1.000) or accuracy (P = 0.180). Power analysis demonstrated that a sample size of 685 lymph node groups (98 patients) would be necessary to demonstrate that PET/CT was more accurate than MRI (alpha = 0.05; beta = 0.80). CONCLUSIONS: PET/CT was more sensitive than MRI for detecting lymph node metastases in patients with uterine cervical carcinoma.     

盆腔淋巴结分布与子宫颈癌常规盆腔照射野的关系

目的利用CT模拟了解子宫颈癌常规盆腔照射野剂量分布与盆腔淋巴结的关系,探讨较合理的盆腔设野方法。方法对100例子宫颈癌患者进行CT模拟扫描,在放射治疗计划系统上按常规盆腔照射野制定治疗计划,得到常规盆腔照射野95%等剂量曲线图。测量髂总动脉长度和盆腔照射野内的髂总动脉长度,髂总动脉髂内外动脉分叉处内侧缘距盆腔中线的距离,95%等剂量曲线与照射野边界的距离。结果56例常规盆腔照射野内髂总动脉长度不足2cm。71例左髂总动脉或右髂总动脉分叉处到盆腔中线距离≤1.5cm。95%等剂量曲线与照射野上、下、左、右界中位距离分别为1.0cm、0.9cm、0.4cm和0.5cm。结论子宫颈癌常规的盆腔照射野存在一定的缺陷,可能造成盆腔淋巴结,特别是髂总淋巴结的照射剂量不足或漏照。建议在CT模拟定位下进行盆腔野的设计,或参考CT图像设计盆腔照射野,盆腔中线挡铅的照射用盆腔下段挡铅（子宫底平面以下）的替代。     

早期宫颈癌盆腔淋巴结转移的分布

目的 探讨早期宫颈癌患者盆腔淋巴结转移的规律,提出宫颈癌盆腔淋巴结三级分站的可行性.方法 选取196例行广泛子宫切除和盆腔淋巴清扫术的Ⅰa2～Ⅱa期宫颈癌患者为研究对象,术前在宫颈肿瘤周围黏膜下3、6、9、12点处分别注射99mTc-硫胶体0.5ml,术后将清扫的盆腔淋巴结用闾讲庖墙刑逋馓讲?确定放射活性计数比同侧淋巴结升高5倍者为前哨淋巴结,将切除的盆腔淋巴结连续切片行HE染色进行病理检测.结果 共检出41例患者的83枚转移盆腔淋巴结,其中宫旁和闭孔淋巴结转移65枚,髂内外淋巴结转移17枚,髂总淋巴结转移1枚.22例宫旁淋巴结转移患者中,同时伴有髂内淋巴结转移者3例,髂外淋巴结转移者5例,髂内和髂外淋巴结均转移者1例.19例闭孔淋巴结转移患者中,同时伴有髂内淋巴结转移者3例,髂外淋巴结转移者4例.x2检验显示,宫旁和(或)闭孔淋巴结转移与盆腔其他区域淋巴结的转移呈正相关.共检出转移前哨淋巴结81枚,其中宫旁和闭孔前哨淋巴结转移64枚,髂内外前哨淋巴结转移17枚.宫旁和(或)闭孔淋巴结转移组与非转移组比较,患者的1和3年生存率差异无统计学意义,但非转移组患者的5年生存率(93.2%)明显高于转移组(65.1%).结论 宫颈癌患者的盆腔淋巴结转移分为三站是可行的,第1站为宫旁和闭孔区域淋巴结,第2站为髂内和髂外淋巴结,第3站为髂总和腹股沟深淋巴结,可根据转移情况合理地制定患者的治疗方案.     

Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients

We evaluated the additional diagnostic value of magnetic resonance/positron emission tomography (MR/PET) fusion in the detection of metastatic lymph nodes in cervical cancer patients.Seventy nine patients with FIGO stage IB-IVA cervical cancer who had undergone both magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) before lymphadenectomy were included in this study. Image analysis was first performed with PET/CT images only. A second analysis was then performed with MR/PET fused images that focused on the additional information obtained from the MR images. Lymphadenectomy involved removing all visible lymph nodes in the surgical field. To enable nodal group-specific comparisons, para-aortic and pelvic lymph nodes were divided into seven nodal groups: para-aortic, both common iliac, both external iliac and both internal iliac/obturator areas. Histopathological evaluation of lymph nodes has been the diagnostic standard. The value of the additional information from the MR images was evaluated by means of receiver operating characteristic (ROC) analysis.Fused MR/PET rendered readers to detect six more metastatic lymph node groups. The sensitivity and specificity of PET/CT and fused MR/PET were 44.1%, 93.9% and 54.2%, 92.7% respectively. The ROC analysis demonstrated a higher diagnostic performance of fused MR/PET compared to PET/CT alone for detecting lymph node metastases (p = 0.0259).The findings of this study demonstrate the additional diagnostic value of fused MR/PET images compared with PET/CT in the detection of metastatic lymph nodes in patients with uterine cervical cancer.     

同步放化疗对伴有盆腹腔淋巴结转移的宫颈癌患者疗效分析

目的 研究同步放化疗是否提高根治术后伴有盆腹腔淋巴结转移宫颈癌患者的生存。方法 收集2008-2011年间188例行宫颈癌根治术且术后病理伴有盆腹腔淋巴结转移的患者的临床资料,分析同步放化疗的疗效。结果 全组46例患者出现复发转移,单纯放疗组后腹膜、髂总及盆腔非髂总转移者的复发转移分别为4、5、11例(57.1%、55.6%、28.2%);同步放化疗组相应的复发转移分别为5、5、16例(62.5%、25%、15.2%)。与单纯放疗相比,同步放化疗能够明显改善盆腔非髂总、髂总淋巴结转移者的5年生存率(非髂总88.6%∶76.9%,P=0.003;髂总80.0%∶44.4%,P=0.041),而不能改善腹主动脉旁淋巴结转移者的5年生存率(50.0%∶42.9%,P=0.973)。淋巴结转移的部位及同步放化疗是总生存率的影响因素(后腹膜比盆腔非髂总HR=4.259,95%CI=1.700~10.671,P=0.002;髂总比盆腔非髂总HR=2.985,95%CI=1.290~6.907,P=0.011;同步放化疗比放疗:HR=0.439,95%CI=0.218~0.885,P=0.021)。结论 同步放化疗能改善盆腔淋巴结转移患者的生存,但不能改善腹主动脉旁淋巴结转移患者的生存。     

58例卵巢上皮癌腹膜后淋巴结转移的临床分析

目的　分析卵巢上皮癌淋巴结的转移情况 ,为患者选择淋巴结清除术提供科学依据。方法　采集 5 8例卵巢上皮癌患者的病历资料 ,并就患者腹膜后淋巴结转移的影响因素进行单因素和多因素分析。结果　 5 8例卵巢上皮癌患者淋巴结转移率为 4 8.3% ,其中盆腔淋巴结转移率为37.9% ,腹主动脉旁淋巴结转移率为 2 5 .9% ,二者差异无显著性 (P >0 .0 5 )。单因素分析显示 ,肿瘤部位、腹水状况、临床分期和残留病灶直径与腹膜后淋巴结转移有关 ;多因素分析显示 ,临床分期和残留病灶直径为腹膜后淋巴结转移的独立危险因素。结论　对卵巢恶性肿瘤患者采用腹膜后淋巴结清除术极为重要 ,早期患者较为合适 ,而对曾有残留病灶的晚期患者 ,在二次探查术时可以考虑行盆腔和腹主动脉旁淋巴结清除术