超声、 超声造影和X线钼靶联合诊断在早期乳腺癌中的应用

目的:探讨超声、超声造影、X线钼靶及三者联合应用对早期乳腺癌的诊断价值.方法:收集行超声、超声造影、X线钼靶及三者联合诊断的156例乳腺癌和260例乳腺良性病变患者的病例资料,统计分析超声、超声造影、X线钼靶3种检查方法单独及联合使用对早期乳腺癌诊断率的差异.结果:超声单独诊断早期乳腺癌敏感度、特异度、假阳性率、假阴性...     

乳腺血氧功能成像系统在乳腺疾病诊断中的应用

目的探讨乳腺血氧功能成像系统(血氧三算子)在乳腺疾病诊断中的应用价值。方法 2010年3月～9月对120例乳腺疾病进行血氧三算子、超声和乳腺钼靶检查(患者≤35岁不接受钼靶检查),3项检查至少有一项提示有手术指征,通过与术后病理对比,比较3种影像学诊断的准确性、敏感性、特异性、阳性预测值及阴性预测值。结果血氧三算子与超声、乳腺钼靶的准确率分别为93.3%(112/120)、87.5%(105/120)、82.4%(70/85);敏感性分别为93.5%(29/31)、74.2%(23/31)、61.5%(16/26);特异性分别为93.2%(83/89)、92.1%(82/89)、91.5%(54/59);阳性预测值分别为82.9%(29/35)、76.7%(23/30)、76.2%(16/21);阴性预测值为97.6%(83/85)、91.1%(82/90)、84.4%(54/64)。血氧三算子对乳腺病灶诊断的准确性、敏感性、阴性预测值优于乳腺钼靶(Z=2.212,P=0.027;Z=2.623,P=0.009;Z=2.735,P=0.006),但二者特异性和阳性预测值无统计学差异(Z=0.066,P=0.948;Z=0.395,P=0.693)。结论血氧三算子对乳腺病灶诊断具有较高的准确性、敏感性、阴性预测值,对乳腺癌的诊断有较大应用价值。     

超声检测乳腺癌微小钙化的影响因素及与钼靶X线摄影的对比

【摘要】〓目的〓比较超声与钼靶X线摄影检测乳腺癌微小钙化的一致性,探讨影响超声检测乳腺癌微小钙化的影响因素。方法〓87例乳腺癌行超声及钼靶X线摄影检查,分析二者的乳腺病灶及微小钙化的特点,比较二者检测的一致性,分析超声检测微小钙化的影响因素。结果〓超声对病灶的显示率及诊断恶性的准确率均高于钼靶(χ2=9.911,P=0.002)。二者在微小钙化的检出方面无统计学差异(P>0.05),具有较高的一致性(k=0.652)。以钼靶显示微小钙化作为标准,超声检测微小钙化的敏感度为82.1%,特异度为83.3%,假阳性率16.7%,假阴性率为17.9%。钼靶上微小钙化的大小及密集程度影响其超声检测(P<0.05)。结论〓超声较钼靶X线摄影能更敏感地检测及诊断乳腺恶性病变;超声能有效地检测乳腺癌微小钙化,但易受微小钙化的大小及密集程度的影响。     

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??New Evaluation of Ultrasonography for Axillary Lymph Node Metastasis in Breast Cancer LIU Wei, LI Yue, ZHAO Ying, et al.
Corresponding author: WANG Xin, E-mail??xinwangse@126.com
The First Department of Breast Tumor, Tianjin Medical University Cancer Institute and Hospital. Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy,Tianjin, Tianjin 300060, China
Abstract Objective To reduce the postoperative complications of breast cancer and evaluate the value of ultrasonography in detecting ALN metastasis compared with mammography, MRI and PET-CT in patients with breast cancer. Methods 253 breast cancer patients who undergone ultrasonography were studied. The results of the histopathology after surgery were used as diagnostic golden standard. The findings of their sensitivity, specificity, positive predictive value, negative predictive value and accuracy in diagnosing axillary metastases lymph node of breast cancer were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained by ultrasound were 70.6%, 87.4%, 84.8%, 75.0% and 79.1%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained by mammography were 14.6%, 100%, 100%, 53.9% and 57.3%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained by MRI were 50.0%, 100%, 100%, 71.4%, 77.8%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained by PET-CT were 90.0%, 92.3%, 90.0%, 92.3%, 91.3%. The Kappa value was 0.729. The sensitivity, specificity and accuracy of experienced doctors and un-experienced doctors were 69.2%, 87.1% and 78.1% ; 62.5 %, 88.2% and 75.8% respectively??P<0.05??. Conclusion Our study indicates that ultrasonography is better than other examinations for predicting axillary node status, moreover the experiences of doctors affect the predicting results.     

乳管镜对以病理性乳头溢液为首发症状乳腺癌诊断价值分析

目的 评估乳管镜在以病理性乳头溢液为首发症状乳腺癌中的诊断价值。方法 回顾性分析2016年8月至2019年8月中国医科大学附属第四医院（380例）和新疆塔城地区人民医院（30例）收治的共410例以病理性乳头溢液为首发症状病人的临床资料，所有病人术前均行乳管镜、超声及钼靶检查。分析乳管镜检查中与乳腺癌诊断密切相关的因素，比较不同检查方式对乳腺癌诊断的敏感度、特异度、阳性预测值及阴性预测值。结果 410例病人均接受手术治疗，并进行术后病理学诊断，其中乳腺癌31例（7.6%）。乳管镜检查结果中，良性病例与恶性病例的溢液颜色、溢液量及病灶深度差异有统计学意义（P<0.05）。乳管镜对于乳腺癌术前评估诊断的敏感度为90.3%，明显高于超声（61.3%）和钼靶检查（48.4%），三者特异度差异无统计学意义（P>0.05）。超声联合钼靶检查敏感度为71.0%，而在此基础上联合乳管镜检查可使诊断的敏感度提高至93.5%。结论 在以病理性乳头溢液为首发症状乳腺癌的诊断中，乳管镜检查的敏感度显著高于超声和钼靶，增加乳管镜检查能够显著提高乳腺癌诊断的敏感度，避免漏诊。     

乳管镜对以病理性乳头溢液为首发症状乳腺癌诊断价值分析

目的 评估乳管镜在以病理性乳头溢液为首发症状乳腺癌中的诊断价值。方法 回顾性分析2016年8月至2019年8月中国医科大学附属第四医院（380例）和新疆塔城地区人民医院（30例）收治的共410例以病理性乳头溢液为首发症状病人的临床资料,所有病人术前均行乳管镜、超声及钼靶检查。分析乳管镜检查中与乳腺癌诊断密切相关的因素,比较不同检查方式对乳腺癌诊断的敏感度、特异度、阳性预测值及阴性预测值。结果 410例病人均接受手术治疗,并进行术后病理学诊断,其中乳腺癌31例（7.6%）。乳管镜检查结果中,良性病例与恶性病例的溢液颜色、溢液量及病灶深度差异有统计学意义（P<0.05）。乳管镜对于乳腺癌术前评估诊断的敏感度为90.3%,明显高于超声（61.3%）和钼靶检查（48.4%）,三者特异度差异无统计学意义（P>0.05）。超声联合钼靶检查敏感度为71.0%,而在此基础上联合乳管镜检查可使诊断的敏感度提高至93.5%。结论 在以病理性乳头溢液为首发症状乳腺癌的诊断中,乳管镜检查的敏感度显著高于超声和钼靶,增加乳管镜检查能够显著提高乳腺癌诊断的敏感度,避免漏诊。     

Digital Breast Tomosynthesis: A New Diagnostic Method for Mass‐Like Lesions in Dense Breasts

To compare the rates and accuracy of digital breast tomosynthesis (DBT) and 2D digital mammography (DM) for detecting and diagnosing mass‐like lesions in dense breasts. Mediolateral and craniocaudal images taken with DBT (affected breast) and DM (both breasts) of the dense breasts of 631 women were assessed independently using Breast Imaging Reporting and Data System (BI‐RADS) scores. Images were compared for detection and diagnostic accuracy for masses; sensitivity and specificity of diagnosis; false‐negative and recall rates; and clarity of display, particularly of margins and spicules. Histopathology was conducted via surgical biopsies of all patients. The detection and diagnostic accuracy rates of DBT images (84.3% and 82.3%, respectively) were significantly higher than that of DM (77.3% and 73.4%; p < 0.01, both). The sensitivity and specificity of DBT (68.1% and 95.2%) were higher than that of DM (58.8% and 86.7%), whereas the recall rate of DBT was lower (3.6% cf. 9.8%). The number of cases of benign circumscribed masses and malignant spiculated masses detected by DBT (172 and 182) was significantly higher than the number detected through DM (75 and 115; p < 0.01, both). Radiologists assigned higher BI‐RADS scores for probability of malignancy to DBT images than DM, to lesions proved malignant (p = 0.025); for benign cases, the methods were comparable (p = 0.065). Compared with DM, DBT yielded significantly higher rates of detection and diagnostic accuracy for benign and malignant masses, with greater sensitivity and specificity and lower recall rates. In addition, DBT images facilitated analysis of margins, and the rate of accuracy for judgments of malignancy probability was higher, as proved on biopsy.     

Aspiration cytology is superior to Tru-Cut needle biopsy in establishing the diagnosis of clinically suspicious breast masses.

Eighty-one consecutive patients with breast masses clinically suspicious for malignancy were evaluated prospectively. There were 31 benign lesions and 50 malignancies. Clinical diagnosis was correct in 85% (2.5% false negative, 12.5% false positive). Mammography was diagnostic in 52.8% (31.5% false negative, 15.7% false positive). Needle biopsy was accurate in 78.9% (21.1% false negative, 0% false positive). Aspiration cytology was diagnostic in 96.2% (3.8% false negative, 0% false positive). Statistical comparison of all four tests revealed that aspiration cytology was slightly more accurate than physical examination for all lesions (p = 0.07), but significantly more accurate for benign lesions (p = 0.005). Overall, aspiration cytology was significantly more accurate than mammography (p = 0.000001) and needle biopsy (p = 0.008). Only one minor complication, a superficial infection, occurred with aspiration cytology and needle biopsy. Thin-needle aspiration cytology is a benign procedure that appears to be superior to physical examination, mammography, and needle biopsy in establishing the diagnosis of clinically suspicious breast masses.     

Tc-99m-Sestamibi Scintimammography for the Diagnosis of Breast Malignancies

Abstract: Breast cancer is a leading cause of morbidity and mortality in the Western world. The most efficient method for improving the outcome of this disease is early detection. We evaluated the efficacy of Tc-99-sestamibi (MIBI) scintimammography as a method for detection of breast cancer in 212 patients. One hundred forty-nine of these patients had pathological confirmation of the results: 47 cytological and 102 histologic examinations. Sixty-three additional patients were scanned because they belonged to high-risk groups. The results demonstrated that among the 149 patients who had histologic or cytological examinations, positive scans were obtained in 68 patients: 47 of them had breast malignancies and 21 were false positive. Negative scans were obtained in 81 patients: 76 were true negative and in 5 there was a false-negative result. In 63 additional patients in whom no histologic confirmation was obtained, there was a negative scan. In 11 months of follow-up, no malignancy was discovered in this group of patients. The sensitivity, specificity, and positive and negative predictive values were 90.4%, 78.4%, 69.1%, and 93.8%, respectively. Four out of five false-negative results were obtained in patients with nonpalpable lesions smaller than 1 cm in size. Total accuracy was 82.6%. In 182 of the 212 patients examined by scintimammography, mammography was available. MIBI scan was superior to mammography in its sensitivity, 90% versus 80%. Total accuracy of both examinations was similar. MIBI scan is a sensitive method for early detection of breast cancer and should be considered as a complimentary tool to the combination of physical examination and mammography.     

Accuracy of the Combination of Mammography and Sonography in Predicting Tumor Response in Breast Cancer Patients After Neoadjuvant Chemotherapy

Background Residual tumor size after neoadjuvant chemotherapy is an important consideration in surgical planning. We examined the accuracy of the combination of mammography and sonography in predicting pathologic residual tumor size.Methods Tumor size was evaluated by physical examination, mammography, and sonography at diagnosis and before surgery in 162 breast cancer patients who received neoadjuvant chemotherapy. Agreement between the predicted and the pathologic responses and the predicted and the pathologic tumor sizes was calculated. The effect of invasive lobular carcinoma, high nuclear grade, hormone receptor positivity, and the presence of an extensive intraductal component on the accuracy of mammography and sonography in predicting pathologic residual tumor size was analyzed.Results Forty-two patients (25.9%) had a pathologic complete response (pCR). Overall agreement between predicted and pathologic responses was 53% for physical examination, 67% for mammography plus sonography, and 63% for physical examination plus mammography and sonography. The sensitivity of mammography and sonography in predicting pCR was 78.6%, and the specificity was 92.5%; the accuracy was 88.9%. Residual tumor size determined by mammography and sonography correlated with pathologic residual tumor size (r = .662); pathologic tumor size was within .5 cm of predicted in 69.1% of patients. Multivariate analysis showed that pathologic residual tumor size was underestimated for lobular carcinoma and overestimated for poorly differentiated tumors.Conclusions The combination of mammography and sonography has a high accuracy in predicting pCR after neoadjuvant chemotherapy. Agreement of residual tumor size in mammography and sonography with pathologic residual tumor size was moderate.Presented in part at the American Society of Breast Surgeons Seventh Annual Meeting, Baltimore, Maryland, April 5–9, 2006.     

Comparison between sonography and mammography for breast cancer diagnosis in oriental women after augmentation mammaplasty

Augmentation mammaplasty has become more popular in Taiwan. Therefore, clinical imaging is necessary to evaluate those patients who develop breast cancers. The purpose of this study was to evaluate the detection of breast diseases after augmentation mammaplasty by means of mammography and sonography. A retrospective follow-up study and analysis of diagnostic methods including mammography, sonography, physical examination, and aspiration cytology was conducted on 105 patients who underwent augmentation mammaplasty at Kaohsiung Medical University Hospital between 1989 and 2001. A total of 105 patients were identified in this study, and mean follow-up was 4 years. Two tumors from 8 cancer patients were visible on standard mammograms, and seven tumors were diagnosed as cancer by sonography. One of 15 benign breast tumors was interpreted as a suspected cancer, and 7 tumors were interpreted as normal findings on mammograms. Fourteen of 15 benign breast tumors were diagnosed correctly except for one suspicious case examined by sonography. Sonography showed the highest rate of diagnostic accuracy (91.3%) and mammograms had the lowest rate (73.9%). The accuracy rate of physical examination was 73.9%, and aspiration cytology was 90.0% accurate. This study affirms that sonography is a more useful diagnostic tool than mammography in Taiwanese women who have undergone augmentation mammaplasty.     

MRI联合钼靶X线在乳腺导管原位癌的诊断价值

目的探讨MRI联合乳腺钼靶X线诊断乳腺导管原位癌的应用价值。 方法选择2018年2月至2019年2月收治的90例乳腺导管原位癌患者,对所有患者给予乳腺钼靶X线及MRI检查,比较联合检查与单一检查的诊断价值。采用SPSS22.0进行统计分析,年龄和病灶直径计量资料采用( ±s)表示,t检验;将病理诊断作为金标准,分析MRI及联合诊断的敏感度及特异度。计数资料采用n(%)表示,χ²检验,P<0.05为差异有统计学意义。 结果90例乳腺导管原位癌患者均为单发病灶,恶性病灶48例,良性病灶42例。恶性病灶患者的年龄与良性病灶差异无统计学意义(P>0.05),良性病灶肿瘤直径低于恶性病灶(P<0.05)。将病理诊断结果作为金标准,MRI联合乳腺钼靶X线诊断的灵敏度和特异度分别为91.67%和90.48%,均高于单纯MRI的75.00%和71.43%及单纯乳腺钼靶的66.67%和64.29%%,差异有统计学意义(P<0.05)。 结论MRI联合乳腺钼靶X线在诊断乳腺导管原位癌时具有较高灵敏度和特异度,可为临床诊断及判断提供科学依据。     

Sonography versus peritoneal lavage in blunt abdominal trauma

The reliability of sonography and peritoneal lavage in assessing the need for immediate surgical intervention in blunt abdominal trauma was examined in a prospective study (n = 71). Statistical analysis revealed a sensitivity of 100% for peritoneal lavage compared to 84% for sonography; the accuracy was 99% versus 86%, the predictive value 97% vs. 89%. The statistical difference was significant (p less than 0.05). The results demonstrate that sonography cannot replace peritoneal lavage in the diagnosis of blunt abdominal trauma. The discussion of the advantages and disadvantages of both methods shows that sonography and peritoneal lavage are not competing, but rather, are complementary examinations.     

The clinical value of magnetic resonance imaging in the evaluation of meniscal disorders

This prospective double-blind study was designed to evaluate the capability of magnetic resonance imaging to serve as a diagnostic tool in patients who have a clinically suspected disorder of the meniscus. The imaging studies provided a diagnostic accuracy of 72 per cent, a sensitivity of 88 per cent, and a specificity of 57 per cent. The positive and negative predictive values were 66 and 83 per cent. The diagnostic sensitivity was 94 per cent for lesions of the medial meniscus; this value differed significantly from that of 78 per cent for lesions of the lateral meniscus (p less than 0.05). The 37 per cent specificity for lesions of the medial meniscus was extremely low compared with the rate of 69 per cent for lesions of the lateral meniscus (p less than 0.01). In the intermediate part of the meniscus, the diagnostic sensitivity was 37 per cent on the medial side and 23 per cent on the lateral side; these values were significantly less than the average of 74 per cent for the other meniscal segments (p less than 0.001). The imaging studies provided an over-all accuracy of 67 per cent in the detection of degeneration of the meniscus, 78 per cent in the identification of meniscal tears, and 82 per cent in the delineation of postoperative lesions.     

常用乳腺影像诊断方法的比较研究

目的 比较彩色多普勒超声、钼靶和近红外线在乳腺癌及乳腺良性疾病诊断中的作用。方法 以术后病理结果为金标准，比较术前3种检查方法的诊断准确性。结果 共计565例乳腺疾病患者接受检查，其中乳腺癌274例，良性乳腺疾病291例。对乳腺癌彩超、钼靶和近红外线检查的灵敏度分别为83．7％（200／239）、84．2％（64／76）和76．9％（100／130），特异度分别为88．6％（226／255）、93．2％（69／74）和82．6％（114／138），诊断符合率分别为86．2％（426／494）、88．7％（133／150）和79．9％（214／268），其中彩超和钼靶检查的诊断符合率优于近红外线（P〈0．05），尤其对≤2cm的乳腺癌，近红外线对其诊断有较高的假阴性率（48．8％，21／43）。对乳腺炎性病变和导管瘤，彩超的检出率分别为58．8％（10／17）和69．2％（18／26），高于近红外线的检出率[分别为0和23．5％（4／17），P〈0．05和P〈0．01]。对乳腺癌在无查体配合诊断情况下行近红外线检查，其灵敏度和诊断符合率明显下降[灵敏度从76．9％（100／130）降到56．9％（74／130），P〈0．01；诊断符合率从79．9％（214／298）降到61．9％（166／268），P〈0．01]。结论 彩色多普勒超声和钼靶是有价值的常用乳腺影像诊断方法。     

Sixteen-row multislice computerized tomography angiography in the postoperative evaluation of patients with intracranial aneurysms

The goal of this study was to assess the diagnostic accuracy of 16-row multislice computed tomography angiography (CTA) compared with digital subtraction angiography (DSA) in the detection of aneurysm remnants and arterial patency after clipping of intracranial aneurysms. Thirty-seven consecutive patients with 40 clipped aneurysms (39 of which had ruptured) were studied with the aid of postoperative CTA and DSA. CTA was performed with a 16-row multislice CT scanner by using collimation of 0.75 mm. Two neuroradiologists evaluated the image quality of CTA and the presence of the residual aneurysms with a 5-point rating scale. DSA was considered a reference standard. Two aneurysms with incomplete closure were identified by the 16-slice CTA reconstructions. With 16-slice CTA, there were no false-positive results of an aneurysm with incomplete closure in any patient. Arterial patency could be reliably evaluated close to the clip. The sensitivity, specificity, and accuracy of 16-slice CTA for aneurysm occlusion and arterial patency were 100%[97.5% confidence interval (CI): 15.8 - 100%], 100% (97.5% CI: 90.7 - 100%) and 100% (97.5% CI: 91.2 - 100%), respectively. The positive and negative predictive values were 100 and 100%, respectively. The mean duration of the examination was 12 min for CTA and 40 min for DSA (p < 0.05). Sixteen-slice CTA was highly cost effective (p < 0.05). Sixteen-slice CTA is a valuable non-invasive diagnostic modality for the assessment of aneurysm remnants and arterial patency in patients after aneurysm clipping. Its high sensitivity and low cost warrant its use for postoperative routine control examinations following clip placement on an aneurysm.     

经阴道超声及宫腔镜诊断子宫内膜病变

目的探讨经阴道超声(TVS)及宫腔镜(HS)诊断子宫内膜病变的临床价值。方法回顾性分析2008年8月—2011年5月接受TVS、HS和病理检查的疑似子宫内膜病变患者192例,与病理结果对照,评价两种方法诊断子宫内膜病变的敏感度、特异度、阳性预测值、阴性预测值及诊断符合率,并进行统计学比较。结果 TVS诊断子宫内膜异常的敏感度、特异度、阳性预测值、阴性预测值分别为93.60%(161/172)、55.00%(11/20)、94.71%(161/170)、50.00%(11/22);HS诊断子宫内膜异常的敏感度、特异度、阳性预测值、阴性预测值分别为97.67%(168/172)、90.00%(18/20)、98.82%(168/170)、81.82%(18/22)。HS的诊断敏感度、特异度、阳性预测值、阴性预测值均高于TVS;HS及TVS对子宫内膜增生、内膜息肉、黏膜下肌瘤、内膜癌、内膜萎缩的诊断符合率差异均无统计学意义(P均>0.05),慢性非特异性子宫内膜炎、未见异常者的诊断符合率差异有统计学意义(P均<0.05)。结论 TVS可作为子宫内膜病变的首选检查方法,为HS提供导向;TVS与HS相结合,有望成为诊断子宫内膜病变的最佳方法。     

超声造影诊断乳腺占位性病变影响因素

目的 分析超声造影（CEUS）诊断乳腺占位性病变出现假阳性、假阴性结果的影响因素。方法 回顾性分析349例接受常规超声（US）、CEUS及乳腺X线摄影（MG）的女性乳腺单发占位性病变患者,以病理结果为金标准,将CEUS诊断结果分为真阳性、真阴性、假阳性和假阴性。采用单因素及多因素Logistic回归分析筛选CEUS出现假阳性、假阴性结果的影响因素。结果 349个乳腺病变中,良性病变205个,恶性病变144个。CEUS正确诊断127个恶性、170个良性病变,诊断敏感度为88.19%（127/144）,特异度82.93%（170/205）,准确率85.10%（297/349）,假阳性率17.07%（35/205）,假阴性率11.81%（17/144）。单因素及多因素Logistic回归分析结果显示,年龄、病变至乳头距离（DtP）、合并高危病变是CEUS假阳性的影响因素（P均<0.05）;而年龄、病灶最大径（LMD）与CEUS假阴性有关（P均<0.05）。结论 乳腺占位性病变患者年龄、DtP、是否合并高危病变与CEUS假阳性有关;年龄、病灶最大径与CEUS假阴性有关。     

声触诊组织量化成像技术鉴别诊断甲状腺影像报告和数据系统4类甲状腺结节

目的探讨声触诊组织量化(VTQ)成像技术对甲状腺影像报告和数据系统(TI-RADs)4类结节的良恶性鉴别诊断价值。方法对88个常规超声评价为TI-RADs 4类的甲状腺结节行VTQ检查。比较VTQ与TI-RADs分类的诊断效能。结果 88个TI-RADs 4类甲状腺结节中,良性结节56个,恶性结节32个。以TI-RADs 4b类和4c类诊断为恶性结节,其诊断敏感度、特异度、阳性预测值、阴性预测值及准确率分别为90.63%(29/32)、57.14%(32/56)、54.72%(29/53)、91.43%(32/35)及69.32%(61/88)。甲状腺恶性结节VTQ值[(3.26±0.94)m/s]明显高于良性结节VTQ值[(2.03±0.61)m/s,t=7.082,P0.001]。VTQ的最佳诊断界值为2.795m/s,其诊断甲状腺结节良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为78.13%(25/32)、91.07%(51/56)、83.33%(25/30)、87.93%(51/58)及86.36%(76/88)。VTQ值诊断TI-RADs 4类甲状腺结节良恶性的特异度及阳性预测值明显高于TI-RADs分类(P均0.05)。结论 VTQ技术有助于TI-RADs 4类甲状腺结节的良恶性鉴别诊断,值得临床推广。     

Role of axillary lymph node dissection after tumor downstaging with induction chemotherapy for locally advanced breast cancer

Background: Induction chemotherapy has become the standard of care for patients with locally advanced breast cancer (LABC) and currently is being evaluated in prospective clinical trials in patients with earlier-stage disease. To better gauge the role of axillary lymph node dissection in patients with LABC this study was performed to assess initial axillary status on physical and ultrasound examination, axillary tumor downstaging following induction chemotherapy, and the accuracy of physical examination compared with axillary sonography in predicting which patients will have axillary lymph node metastases found on pathologic examination. Methods: Between 1992 and 1996, 147 consecutive patients with LABC were registered in a prospective trial of induction chemotherapy using 5-fluorouracil, doxorubicin, and cyclophosphamide. Physical and ultrasound examinations of the axilla were performed at diagnosis and after induction chemotherapy. Segmental resection with axillary lymph node dissection or modified radical mastectomy was performed, followed by postoperative chemotherapy and irradiation of the breast or chest wall and regional lymphatics. Results: Following induction chemotherapy, 43 (32%) of the 133 patients with clinically positive lymph nodes on initial examination had axillary tumor downstaging as assessed by physical and ultrasound examination. The sensitivity of axillary sonography in identifying axillary metastases was significantly higher than that of physical examination (62% vs. 45%,P=.012). The specificity of physical examination (84%) was higher than that of sonography (70%), but the difference did not reach statistical significance. Among the 55 patients in whom the findings of both physical and ultrasound examination of the axilla were negative following induction chemotherapy, 29 patients (53%) were found to have axillary lymph node metastases on pathologic examination of the axillary contents. However, 28 (97%) of these patients had either 1 to 3 positive lymph nodes or only micrometastases 2 to 5 mm in diameter. Conclusions: Preoperative clinical assessment of the axilla by physical examination combined with ultrasound examination is not completely accurate in predicting metastases in patients with LABC following tumor downstaging. However, patients with negative findings on both physical and ultrasound examinations of the axilla may be potential candidates for omission of axillary dissection if the axilla will be irradiated because minimal axillary disease remains. Patients who have positive findings on preoperative physical or ultrasound examinations should receive axillary dissection to ensure local control. A prospective randomized trial of axillary dissection versus axillary radiotherapy in patients with a clinically negative axilla following induction chemotherapy is currently underway.Presented at the 51st Annual Cancer Symposium of The Society of Surgical Oncology, San Diego, California, March 28, 1998.