淋巴结影像学在乳腺癌淋巴结转移中的应用

<正>明确是否出现淋巴结转移以及转移淋巴结的部位、数目,对肿瘤诊断、分期、治疗及预后判断具有重要的指导意义。目前乳腺癌患者主要是通过术前、术中注射蓝色染料对淋巴结活检进行病理诊断,但该法有创、手术时间延长、并发症增多,而     

预测乳腺癌腋窝淋巴结转移的研究进展

19世纪，乳腺癌被认为是局部病变，沿淋巴管转移扩散，且遵循逐级转移即从第一站淋巴结转移到第二站淋巴结，然后再转移到全身的规律。Halsted根治术就是依据这个理论设计的手术方式。直到20世纪60年代Fisher提出乳腺癌是全身性疾病，在病程的早期即可发生全身转移。乳腺癌局部病变的理论便为全身性疾病的理论所替代。并且，依据预后因素用“预后好”或“预后差”的乳腺癌替代“早期”或“晚期”乳腺癌。     

高频彩超诊断乳腺癌腋窝淋巴结转移的价值

目的 探讨高频彩超对乳腺癌腋窝淋巴结转移的诊断价值.方法 采用高频彩超对87例乳腺癌腋窝肿大淋巴结进行术前形态、大小、数目、内部回声、血流动力学指标分析.结果 病理证实的68例转移性淋巴结形态改变,淋巴结长0.8～3.9 cm,长短径之比<2,内部为不均匀的低回声,淋巴结皮质不均匀增厚,淋巴结门部强回声消失或偏移,血流分布状态呈周边型或混合型.结论 转移性淋巴结在形态、大小、数目、内部回声、血流分布方面有较为特征性的表现.     

高频彩超诊断乳腺癌腋窝转移性淋巴结的临床价值

 目的　评价彩超与临床触诊在诊断乳腺癌腋窝转移性淋巴结中的价值。方法　 60例乳腺癌行腋窝淋巴结清扫术患者作术前前瞻性彩超检查 ,并和术后病理对照 ,双盲法观察分析影像所见 ,将其结果做统计学处理。结果　在 60例乳腺癌腋窝淋巴结清扫术后病理检查中 3 3例有转移性淋巴结。临床触诊检出其中 1 7例 (敏感性 5 1 .5 %、特异性 88.9%、准确性 68.3 % ) ,彩超检出 2 8例 (敏感性 84.8%、特异性1 0 0 %、准确性 88.3 % )。彩超可确诊 68.7%临床漏诊的隐匿性转移淋巴结。结论彩超明显优于临床检查 ,是目前预计腋窝淋巴结是否受累的较准确方法     

乳腺癌腋窝淋巴结转移规律数学模型的建立

目的：建立一个数学模型，对不完全腋窝淋巴结清扫的患者应用Ⅰ级淋巴结的信息预测Ⅱ、Ⅲ级淋巴结的状态，以指导术后辅助治疗。方法：连续收集９０例女性乳腺癌初治患者行全腋窝淋巴结清扫术的资料，全组共被切出１７９３枚淋巴结，平均每例１９．９２枚；Ⅰ、Ⅱ和Ⅲ级分别为８５６（４７．７４％），６２０（３４．５８％），３１７（１７．６８％）枚，Ⅰ级淋巴结平均为９．５１枚。采用ＳＰＳＳ软件行Ｌｏｇｉｓｔｉｃ多元回归判     

影像学诊断直肠癌转移淋巴结的研究进展

肿瘤TNM分期系统是评价结直肠癌患者预后的金标准和制定治疗方案的依据~[1]。分期越晚,术后局部复发率越高,Duke’s B、C期肿瘤复发率高于A期~[2]。随着肿瘤分期的准确性逐渐提高以及外科手术方案优化、辅助性放化疗的应用,直肠癌患者的术后生存率升高,但肿瘤局部复发依然是影响直肠癌患者生存的重要因素之一~[3]。淋巴结转移与直肠癌术后复发密切相关。约30%～40%直肠癌患者伴淋巴结转移,其中约40%发生于肠系膜     

乳腺癌腋窝淋巴结转移的MRI评价

乳腺癌是女性最为常见的恶性肿瘤之一,腋窝淋巴结的转移情况对疾病分期、治疗手段的选择以及预后判断具有重要意义。现阶段临床多采用超声或前哨淋巴结活检来评价腋窝淋巴结有无转移,但上述方法存在不足之处或伴随并发症的发生。磁共振成像近年来被越来越多地运用于乳腺癌腋窝淋巴结转移的无创诊断。本文将回顾通过MRI直接评价乳腺癌腋窝淋巴结转移（而非通过肿瘤本身的MRI相关特征预测腋窝淋巴结转移）的文献,并将MRI的相关特征用于诊断乳腺癌腋窝淋巴结转移的准确性进行综述。本文发现目前的研究结果之间存在差异,使用MRI多参数联合可提高诊断准确性,并且影像组学的出现也为诊断带来了新的机遇。     

乳腺癌腋窝淋巴结跳跃式转移规律的临床研究

目的 乳腺癌能够跳过低水平(1evel Ⅰ)的淋巴结而直接转移到高水平的淋巴结(levelⅡ、Ⅲ)的现象已经被认识许多年了，称之为跳跃式转移。腋窝淋巴结跳跃式转移发生率大约在5．5％～19．2％之间。认识发生跳跃式转移的重要性在于这类患者如果未行完全腋窝淋巴结清除术将会被错误分期，将不能接受到恰当的辅助治疗，增加了腋窝复发的危险性。由于对于腋窝淋巴结转移途径的认识程度决定着乳腺癌外科手术淋巴结清除的范围，所以对腋窝淋巴结转移模式要有一个清晰、完整、准确的认识。随着前哨淋巴结研究的深入开展，跳过前哨淋巴结的转移也越来越受到人们的重视，认清跳跃式转移的发生规律对于指导临床治疗有着极其重要的意义，并且可以为哨位淋巴结切检取代全腋窝淋巴结切除在临床广泛应用提供理论上的依据。     

乳腺癌腋窝淋巴结转移的多因素分析

目的:研究乳腺癌腋窝淋巴结转移与年龄、民族、初潮年龄、第一胎生育年龄、绝经、绝经年龄、病程、哺乳时间、妊娠次数、肿瘤部位、肿瘤大小（B超、钼靶、MRI分别测值）、病理分型、雌激素受体（ER）、孕激素受体（PR）、C-erbB-2基因表达之间的关系及规律,为乳腺癌手术中腋窝淋巴结清扫术的指征提供理论依据。方法:回顾性分析356例乳腺癌患者的临床资料。结果:腋窝淋巴结转移228例（64%）,无转移128例（36%）;腋窝淋巴结转移与第一胎生育年龄、妊娠次数、哺乳时间、病程、肿瘤大小(B超、钼靶、MRI)、肿瘤部位、病理类型相关（P<0.05）,P值分别为0.007、0.005、0.006、0.022、（0.001、0.000、0.020）、0.009、0.000。结论:腋窝淋巴结的转移受多种因素影响。     

直肠癌术前淋巴结转移的影像学研究进展

直肠癌是最常见的癌症之一,严重危害人类健康。术前新辅助放化疗已经广泛应用于直肠癌患者,其治疗决策在很大程度上取决于患者是否存在淋巴结转移,这就为淋巴结的术前诊断提出了很大的挑战。目前,评估淋巴结状态通常采用影像学方法,传统CT、MRI及PET/CT对转移淋巴结的诊断效能并不理想,近年来,随着双能CT及动态对比增强磁共振等新的影像学技术的发展,为术前诊断淋巴结转移提供了新的可供选择的方法,越来越多的研究显示,这些新技术对于直肠癌转移淋巴结的诊断准确性已经明显超过了传统的影像学方法。本文将介绍近年来新的影像学诊断方法对于直肠癌转移淋巴结的诊断价值。     

Predictors of positive axillary lymph nodes in breast cancer patients with metastatic sentinel lymph node

INTRODUCTION: Breast cancer with metastatic sentinel lymph nodes (SLN) may have clinico-pathologic factors associated with the presence of positive non-sentinel axillary nodes (NSLN). The aim of the present study was to determine factors that predict involvement of NSLN in breast cancer patients with positive SLN. MATERIAL AND METHODS: A prospective database search identified 80 patients who underwent SLN biopsy for invasive breast cancer between January 1999 and August 2002. Clinico-pathologic data was analyzed to determine factors that predicted additional positive axillary nodes. RESULTS: A total of 23 patients had positive SLN and underwent conventional axillary lymph node dissection. Statistical analysis revealed that lympho-vascular invasion (p~0.00000), SLN metastasis >2 mm (p=0.002), and the presence of extra-nodal involvement (p=0.002), were positive predictors of the metastatic involvement of NSLN. CONCLUSIONS: The likelihood of positive NSLN correlates with pathologic parameters such as the presence of lympho-vascular invasion, size of the SLN metastasis, and extra-nodal involvement. These data may be helpful with the regard to the decision to undertake axillary dissection in breast cancer patients with metastatic sentinel lymph nodes.     

超声造影对乳腺癌腋窝淋巴结转移的诊断价值

目的探讨超声造影对诊断乳腺癌腋窝淋巴结转移的应用价值。方法对141例浸润型乳腺癌患者行乳腺病灶及腋窝淋巴结常规超声检查后,再对腋窝淋巴结进行超声造影,先用目测法观察淋巴结超声造影增强模式,再用QontraXt软件分析超声造影时间-强度曲线参数。根据超声造影灌注特点,将腋窝淋巴结分为淋巴结转移组（有转移组）和无淋巴结转移组（无转移组）,并与病理检查结果相比较。增强模式之间的对比采用x2检验,造影参数用单因素方差分析。结果淋巴结有转移组灌注模式表现为不均匀增强型或无增强,淋巴结无转移组表现为均匀型增强,两组灌注模式之间的差异有统计学意义（P=0．000）。两组造影剂到达时间、达峰时间、峰值强度之间的差异无统计学意义（P值分别为0．129、0．094、0．140）。淋巴结实质内高灌注区与低灌注区的差值（SImax-SImin）有转移组大于无转移组（P=0．000）。以SImax-SImin）值大于28为最佳临界点,鉴别的灵敏度为93．3％,特异度为80．8％。结论超声造影对鉴别乳腺癌腋窝淋巴结转移有-定的临床价值。     

Advantages of preoperative localization and surgical resection of metastatic axillary lymph nodes using magnetic seeds after neoadjuvant chemotherapy in breast cancer

PurposeTo assess the safety and effectiveness of magnetic seeds in preoperative localization and surgical dissection of metastatic axillary lymph nodes (LN+) in breast cancer patients with axillary involvement, after neoadjuvant chemotherapy (NAC). In addition, to assess the impact of targeted axillary dissection (TAD) in reducing the rate of false negatives (FN) in sentinel lymph node biopsy (SLNB).Materials and MethodsA cross-sectional prospective cohort study was conducted from April 2017 to September 2019, including breast cancer patients with axillary lymph node involvement treated with NAC. Prior to NAC, the LN+ were marked by ultrasound-guided clip insertion. After NAC, a magnetic seed (Magseed®) was inserted in the clip-marked lymph node (MLN). During surgery, the MLN was located and removed with the aid of a magnetic detection probe (Sentimag®) and the sentinel lymph node was removed. Axillary lymph node dissection (ALND) was used to determine the rate of FN for SLNB alone and the combination of SLNB and MLN dissection, called TAD.ResultsThe study included 29 patients (mean age, 55; range, 30–78 years). Selective preoperative localization and surgical dissection were successful for all 30 MLNs (100%). The MLN corresponded to the SLN in 50% of cases. After ALND, there were 21.4% (3/14) FN with SLNB alone and 5.9% (1/17) with TAD.ConclusionsFollowing NAC, selective surgical removal of MLN by preoperative localization using magnetic seeds is a safe and effective procedure with a success rate of 100%. Adding TAD reduces the rate of FN associated with SLNB alone.     

Long-term breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes

Purpose

Better tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone.

Methods

Data from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis.

Results

The combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus  > 1–2.5 cm (1.45, 1.47), age ≥ 50 versus < 50 year (0.61, 0.84) and year ≥ 2000 (0.67, 0.49). Utilization of DS combined with tumor size and age at diagnosis predicted more women with very low (≤ 8%) or higher (> 15%) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone.

Conclusions

The combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.

     

Postmastectomy radiotherapy in women with breast cancer metastatic to one to three axillary lymph nodes

The influence of postmastectomy radiotherapy on survival has long been debated. Early randomized trials established a clear role for adjuvant postmastectomy chest wall radiotherapy (PMCWRT) in reducing locoregional recurrence (LRR), and PMCWRT became standard therapy for patients at high risk of LRR: those with T3 or T4 tumors and four or more involved lymph nodes. However, without effective systemic therapy, distant metastases limited any effect of improved local control on overall outcome, and radiotherapy showed no benefit in survival. In fact, early meta-analyses showed a negative impact of radiotherapy on survival. As data and techniques matured, a favorable influence of PMCWRT on breast cancer-specific mortality emerged but was offset by a radiotherapy-related increase in vascular mortality. Improvements in radiotherapy delivery to increase efficacy and reduce toxicity, restriction of PMCWRT to patients at intermediate or high risk of LRR after mastectomy, and improved distant control of disease with systemic therapy are expected to bring the greatest likelihood of a survival advantage from locoregional control. Three randomized trials with sufficient follow-up meet these criteria. All demonstrate significant improvement in overall survival with PMCWRT. However, the trials were not designed to specifically address the benefit of PMCWRT in patients at intermediate risk of LRR (those with T1 or T2 tumors and one to three involved lymph nodes). These findings have been discussed in a host of publications and conferences in light of historical negative results. This review focuses on the recent data on PMCWRT in patients with one to three involved nodes.     

Tuberculosis of axillary lymph nodes with primary breast cancer

A rare case of tuberculosis of axillary lymph nodes occurring with primary breast cancer is presented. A 78-year-old woman with no history of pulmonary tuberculosis was admitted to our hospital to undergo examination for a lump in her right breast. The tumor was in the upper outer quadrant of the right breast. On palpation, the tumor was 1.2 cm in diameter and axillary lymph node swelling was noted. Mammography disclosed a spiculated mass and swelling and calcification of the axillary lymph nodes. Sonography showed an irregular hypoechoic mass in the right breast and lymph node swelling in the right axilla, indicating breast cancer with axillary lymph nodes metastases. Chest X-ray showed clustered calcifications in the right axilla and a granular shadow in the right upper lobe. Breast conserving therapy was carried out. Invasive papillotubular carcinoma of the right breast and granulomas with calcification of lymph nodes, compatible with tuberculosis, was diagnosed. Tubercle bacillis were detected by culture of lymph nodes. This case suggests that X-ray is useful for diagnosing lymph node tuberculosis. Lymph node tuberculosis should be suspected when lymph node swelling is noted and X-ray shows clustered calcifications in axillary lymph nodes.     

Presence of breast cancer antigens in uninvolved axillary lymph nodes

Monoclonal antibodies which bind to breast cancer have been used to evaluate the detection of metastatic disease in axillary lymph nodes. Three monoclonal antibodies (H59, H71, and H72) were reacted with tissue sections of primary tumors and axillary nodes from 24 mastectomy specimens and four specimens from glandular mastectomies for benign disease. All three antibodies had been shown to react with subsets of normal and malignant breast tissue; did not bind erythroid, myeloid, or lymphoid tissue; and recognized antigens in paraffin-embedded tissue. The antibodies recognized cell surface antigens, and H59 and H72 bound to glycoproteins which are either sloughed or secreted. Primary tumors and tumors in lymph nodes from the same specimen were always bound by the same antibodies. Antibodies detected unrecognized microscopic tumor in nodes from one previously node-negative specimen and two specimens with positive nodes. This suggests that monoclonal antibodies may be useful for detecting metastatic breast cancer in nodes which by light microscopy are negative. Moderate binding of H59 and H72 antibodies to sinus histiocytes and perivascular cells was observed in all uninvolved nodes with sinus hyperplasia obtained from benign and malignant specimens. Thus, breast antigens can be identified in hyperplastic nodes in patients with no evidence of breast cancer. The antigens are detected predominately in the lymphoid sinuses and are bound to nonneoplastic cells. Therefore, breast antigens are regularly being processed and presented by normal lymphoid cells within the sinus. The binding of these monoclonal antibodies to axillary lymph nodes does not necessarily indicate the presence of metastatic disease. Dense binding to paracortical single cells was observed in tumor-containing lymph nodes and in uninvolved nodes obtained from mastectomy specimens with breast cancer. These cells are infrequent, and their number in an uninvolved node correlates with the pathological stage. They represent either binding to isolated lymphoid cells or metastatic tumor. Studies are under way to determine the origin of these cells.     

Statistical distribution of involved axillary lymph nodes in breast cancer

Our aim is to characterize the statistical distribution of the number of involved lymph nodes in breast cancer. The material uses a sample of 109618 women from the US SEER (Surveillance, Epidemiology, and End Results). In a first analysis, we observed a log-concave distribution with overdispersion which excluded a Poisson stochastic process. A Negative Binomial (NB) provided an acceptable fit. Overdispersion implies that there are patients who are more at risk than expected, and/or cascade processes in which the variability increases when there are more involved lymph nodes. In a second series of analyses, we applied predictive models taking into account or not the NB. Logistic models, commonly used, allow only the prediction of nodal status, and we found a poor predictive value. A NB generalized linear regression (NBGLR) allowed us to model the number of involved nodes. We argued that the approach of modeling the number of nodes, and not merely the nodal status, allows a grading of nodal involvement risk and might identify patients for whom neoadjuvant treatment would be justified. Incidentally, the NBGLR found in our sample a seasonal factor affecting the numbers of nodes, suggesting the variability of medical practice, which might warrant further investigation.