42例恶性淋巴瘤的超声诊断及临床分析

目的探讨恶性淋巴瘤的声像图表现及超声检查的临床意义.方法对42例恶性淋巴瘤进行彩超、临床、病理分析.结果恶性淋巴瘤可发生于全身一个或多个部位,表现为单纯淋巴结肿大和多个脏器受累,前者声像图为界限清晰的堆积或排列状低回声结节,后者为该脏器肿大,内见无包膜的片状或境界清晰的结节状回声.结论超声检查对恶性淋巴瘤的临床诊断、治疗具有重要意义.     

灰阶超声与彩色多普勒超声对乳腺肿块的诊断价值分析

目的 分析乳腺肿块的灰阶声像图与彩色多普勒血流特征,探讨其对乳腺肿块的诊断和鉴别良、恶性的价值.方法 对经病理证实的患者的52例乳腺恶性肿块和45例良性肿块的声像图资料进行回顾性分析.结果 恶性肿块的灰阶网像特点为:形态及边界不规则,见毛刺样或蟹足样改变,边缘见高回声晕带,内部为不均匀回声,见沙砾样钙化点或簇状分布,肿块纵横径比>1,后方有衰减;彩色多普勒分级大多数为Ⅱ～Ⅲ级,阻力指数(RI)值>0.70,同侧腋窝大多淋巴结明显肿大,血流较丰富.乳腺良性肿块灰阶声像图大多表现为:形态规则,边缘光整,内回声均匀,侧缘回声减弱,纵横径比<1;彩色多普勒分级0～Ⅰ级,RI值<0.70,同侧淋巴结大多无明显肿大.结论 乳腺肿块良、恶性的判断仍以灰阶声像图为基础,结合彩色多普勒血流特点在鉴别诊断上具有较高的临床应用价值.     

超声在评价颈部恶性肿大淋巴结中的应用

背景与目的：转移癌与淋巴瘤是引起颈部恶性淋巴结肿大的常见原因。本研究通过两者的二维超声和彩色多普勒血流显像的不同表现,探讨超声在颈部恶性淋巴结诊断中的价值。方法：取我院2006年1月～2008年12月间99例颈部恶性淋巴结肿大患者和40例健康人为观察对象,根据病理结果将患者分为54例转移癌组和45例淋巴瘤组。采用高频超声进行观察,包括肿大淋巴结的形态、长短径比值（L／S）、内部回声、淋巴门的情况、血流分布特征,并对测量参数进行统计学分析。结果：和良性淋巴结比较,恶性淋巴结的形态趋于圆形,L／S值小于对照组,以低回声为主,形态多样,易于融合,淋巴门缺失或移位,转移癌组可钙化和液化。转移癌组和淋巴瘤组声像图和血流特征存在差异,并可与良性淋巴结进行鉴别。结论：超声可作为评价颈部肿大恶性淋巴结的手段之一。     

颈部淋巴结病变超声探讨

目的 探讨各种病因所致的颈部淋巴结肿大的超声诊断及鉴别诊断。方法 用7.5MHz高频探头,对74例颈淋巴结肿大患者的不同声像特征进行探查分析。结果 对颈部淋巴结肿大的良、恶性进行声像图的鉴别,与病理组织学对照,准确率为80％。结论 超声显像对颈部淋巴结病变有重要临床意义。     

彩色多普勒超声诊断乳腺良恶性病变的临床意义

目的 探讨彩色多普勒超声对乳腺良恶性病变的诊断价值.方法 对185例经手术病理证实为乳腺良恶性病变的高频声像图及CDFI表现进行回顾性分析和对比.结果 良性疾病血流检出率为33%,恶性为92%,两者有显著差异.良恶性病变的声像图在边界回声及形状、包膜内部回声和后壁回声及声影等方面也有显著差异.结论 超声高频声像图及彩色多普勒的应用使乳腺良恶性病变的诊断及鉴别诊断符合率大大提高.     

彩超对甲状腺乳头状微癌的诊断价值

目的：探讨彩色超声对甲状腺乳头状微癌的诊断价值.方法：对48例甲状腺乳头状微癌的彩色多普勒声像图特征及颈淋巴结转移的特点进行分析.结果：根据超声图像的边界、包膜、内部回声、微钙化及颈部淋巴结的特征可以对甲状腺乳头状微癌进行诊断，超声诊断符合率72.9%.按声像图特征分为两种类型：低回声型和低晕环型.两种类型在出现毛刺征和颈部淋巴结转移上比较差异有统计学意义（P＜0.05），在血流程度分级、微钙化发生率上比较差异无统计学意义（P＞0.05）.结论：彩超可以对甲状腺乳头状微癌的诊断及手术治疗提供有价值的参考依据.     

常规超声联合超声造影在恶性肿瘤新发锁骨上肿大淋巴结诊断中的价值

目的: 探讨常规超声联合超声造影对恶性肿瘤锁骨上新发肿大淋巴结的诊断价值。方法：对60例符合纳入标准的锁骨上新发肿大淋巴结行常规超声及超声造影检查,并与病理或随访结果对照,观察60枚淋巴结的灰阶超声、彩色多普勒超声及超声造影表现,分析声像图及所测数据与不同类型淋巴结间的关系。结果: 共计41枚反应性增生性淋巴结,19枚转移性淋巴结。60枚锁骨上淋巴结最大径约0.5～1.8cm,常规超声显示21枚淋巴结皮质增厚,39枚淋巴结皮髓质正常结构消失,23枚淋巴结内未检出血流信号。超声造影显示31枚淋巴结为中央型增强,12枚淋巴结为周围型增强,17枚淋巴结为混合型增强。转移性与反应性淋巴结的Atm、Grad差异无统计学意义,两组间TtoPK的差异有统计学意义。其中淋巴结纵横比＜1.5、皮髓质正常结构消失、超声造影的增强类型为周围型或混合型是诊断转移性淋巴结的重要依据。结论: 对于恶性肿瘤患者,治疗中或治疗后出现的新发肿大淋巴结常规声像图多不典型,超声造影是重要的辅助诊断方法,二者联合可以提高诊断准确率。     

EBUS-TBNA超声内镜对纵隔肿大淋巴结良恶性的鉴别诊断价值

目的:分析超声内镜引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)术中肿大纵隔淋巴结的超声图像特点,探讨EBUS-TBNA超声内镜对纵隔淋巴结良恶性的鉴别诊断价值,以期提高EBUS-TBNA对纵隔淋巴结恶性病变的活检率。方法:回顾性分析2014年10月至2018年11月行EBUS-TBNA患者的超声内镜图像。我们使用以下EBUS超声内镜特征来预测淋巴结的良恶:回声,长轴长度,短轴长度,纵横比,形态,边界,淋巴门有无,淋巴结内血流信号分级。将超声检查结果与最终病理结果或临床随访结果进行比较。采用SPSS 20.0软件进行统计学分析,采用logistic回归分析评价肿大淋巴结EBUS-TBNA超声内镜下的特征与良恶性的相关性,以 P<0.05 为标准判定差异有统计学意义。结果:对130例纵隔淋巴结肿大患者的227个淋巴结进行回顾性分析,67.4%的肿大淋巴结被证实为恶性转移。Logistic回归分析显示回声、长轴及短轴的长度、正常淋巴门结构的消失是诊断恶性淋巴结的独立预测因素。结论:纵隔恶性淋巴结具有一定的超声特征,可以通过这些超声特征提高EBUS-TBNA对纵隔恶性淋巴结的检出率。     

脾脏肿瘤的超声诊断

为了总结脾脏不同占位性病变的超声特征,将32例脾脏肿瘤按术后病理分类,分别对其术前超声图像进行回顾性分析总结。结果脾脏血管瘤与肝脏血管瘤声像图表现一致,形态规则,边界清晰,无包膜,后方回声无衰减;原发性脾脏恶性淋巴瘤可呈弥漫性低回声,形态不规则,边界不清晰或呈局限性低回声或蜂窝状低回声,边界清晰,形态规则,内部回声不均匀,后方回声可轻度增强;脾脏转移瘤呈无回声型、低回声型、高回声型及牛眼征4种不同类型的回声。初步研究结果提示,超声检查对脾脏肿瘤具有较高的影像学诊断价值。     

甲状腺癌颈部淋巴结转移高频超声的鉴别诊断价值

目的：探讨高频超声对甲状腺癌患者颈部肿大淋巴结转移的鉴别诊断价值。方法：对甲状腺癌患者颈部淋巴结进行评估,用高频超声诊断并测量淋巴结,记录形态、回声、大小、部位,结果由病理证实。结果：77例甲状腺癌患者中45例出现颈部淋巴结转移,绝大多数转移淋巴结为圆形,无淋巴门的低回声结节。淋巴结的形态对提示转移较为可靠,圆形、纵横径比小于2的低回声淋巴结常提示转移。在转移性病灶中无淋巴门,内部有囊变或钙化明显较良性多见。转移性淋巴结更多位于颈部下1/3处。结论：高频超声对甲状腺癌患者颈部肿大淋巴结转移有较高的诊断准确率,能为临床诊断、治疗提供参考。     

Malignant granulosa cell tumor of the testis associated with gynecomastia and long survival.

A case is reported of classic granulosa cell tumor of the testis with metastases to the retroperitoneal lymph nodes occurring in a 26-year-old man. The patient had left-sided testicular enlargement and bilateral gynecomastia. He was treated by radical orchiectomy, retroperitoneal lymph node dissection, and radiation therapy and is well without evidence of disease 14 years after diagnosis. This is the first documented case of granulosa cell tumor of the testis with metastases and long remission after successful therapy to the authors' knowledge.     

支气管超声弹性成像技术对肺门及纵隔淋巴结良恶性鉴别诊断的临床价值*

目的: 探讨支气管超声弹性成像技术在肺门及纵隔淋巴结良恶性鉴别诊断中的临床价值。 方法: 选取2015年3月至2017年6月就诊于兰州大学第二医院行胸部CT提示肺门或纵隔淋巴结肿大,常规行经支气管镜超声引导针吸活检术（endobronchial ultrasound-guided tansbronchial needle aspiration,EBUS-TBNA）检查的68例患者,共穿刺121枚淋巴结,分别对目标淋巴结行支气管镜下超声及弹性成像检查,记录常规超声和弹性成像的各个参数。以EBUS-TBNA穿刺的病理结果作为诊断的“金标准”,计算常规超声和弹性成像各个参数的诊断敏感度和特异性,运用Logistic回归分析,评价对肿大淋巴结良恶性鉴别诊断的临床价值。 结果: 采用超声弹性成像蓝色面积的比例,作为鉴别诊断良恶性淋巴结的最佳诊断界值为0.6,诊断的准确率为87.10%,敏感度为89.20%,特异性为79.33%,阳性预测值为89.23%,阴性预测值为72.31%,受试者工作特征（receiver operator characteristic,ROC）曲线下面积为0.902,诊断价值明显高于常规超声下各参数和弹性评分;Logistic回归分析显示肺门和纵隔肿大淋巴结中影响其良恶性的主要因素为超声下病变短径、边界、回声均匀、血供及弹性成像蓝色面积的比例。 结论: 超声弹性成像蓝色面积的比例对肺门和纵隔淋巴结良恶性的鉴别诊断以及精准引导EBUS-TBNA操作具有较高的临床价值。      

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     

Retroperitoneal mature teratoma after orchidectomy for a stage IB pure embryonal testicular carcinoma

Nonseminomatous germ cell tumor of the testis stage I will relapse in approximately 30% of patients in the first year after orchidectomy. We report a 19-year-old patient on active surveillance who presented with a retroperitoneal lymph node enlargement suggestive of metastatic disease more than 1 year after the initial diagnosis of embryonal carcinoma stage IB. Complete resection of the lymph node was performed and showed the presence of mature teratoma. Our patient had an unusual case of metastasis formation of benign histology of a previously removed highly malignant primary tumor confined to the testis.     

Acquired ichthyosis as a paraneoplastic syndrome in Hodgkin’s disease

An 80-year-old man was admitted to hospital with low-grade fever, weight loss, asthenia and anorexia. Physical examination revealed generalised ichthyosis with palmoplantar hyperkeratosis. CT scan showed retroperitoneal and inguinal lymph node enlargement. An inguinal lymph node biopsy revealed Hodgkin’s disease (nodular-sclerosing subtype). The patient received chemotherapy, showing a clear improvement of both skin lesions and lymph nodes.     

The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy: results of multivariate analysis.

BACKGROUND: The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy is still unclear. METHODS: High resolution pulsed and color Doppler ultrasound was used prospectively to investigate superficial lymph node enlargement in 71 patients undergoing surgical biopsy at the onset of lymphadenopathy. The aim of this study was to define, in multivariate analysis, the ultrasonographic parameters useful in the differential diagnosis of benign and malignant lymphadenopathy. RESULTS: Volume, vascularization score, pulsatility index, and resistive index were significantly higher in the 53 malignant lymph nodes studied than in the 18 benign lymph nodes studied. The long-to-short axis ratio was significantly lower in neoplastic lymph nodes than in reactive lymph nodes. Stepwise logistic regression selected only the long-to-short axis ratio and the vascularization score as parameters that independently and significantly contributed to the differentiation of neoplastic from reactive lymph nodes. The diagnostic efficiency of the combined criteria evaluated by the area under the receiver operating characteristic curve was 0.8339. CONCLUSIONS: High resolution pulsed and color Doppler ultrasound may provide information that is useful in making correct differential diagnoses of malignant or benign lymphadenopathy.     

Determination of axillary nodal status in surgery of breast carcinoma: A prospective study of thirty-five patients

Thirty-seven axillary status of patients with breast carcinoma was studied with preoperative and peroperative palpation before mastectomy and total axillary dissection. Special attention was paid to the clinical supiciousness and size of axillary nodes. The preoperative axillary palpation gave false diagnosis of axillary content 27% of the time and peroperative, 19%. Of all 249 nodes studied, 54 were found to contain malignant growth in routine histological examination. Mean diameter of malignant nodes was 12.4 mm and of benign nodes, 6.3 mm. The most clinically suspect axillary lymph node gave correct diagnosis of axillary status in 72 % of the cases. The 2 most suspect lymph nodes together were positive in 89%. There was no case with histologically positive axilla where none of the 3 most suspect lymph nodes was malignant. We conclude that at least the 3 most suspect axillary lymph nodes must be removed for histological examination to be sure that axillary metastasizing of breast carcinoma can be found by routine histological examination.     

超声弹性应变率在诊断乳腺癌腋窝淋巴结良恶性中的价值

目的 探讨超声弹性应变率在乳腺癌腋窝淋巴结良恶性的诊断价值。方法 回顾性分析已获得病理组织学诊断的89例乳腺癌患者118个腋窝淋巴结的弹性应变率,比较转移性淋巴结与反应性增生淋巴结的弹性应变率,并绘制受试者工作特征曲线（ROC）。结果 118个腋窝淋巴结转移性淋巴结54个,反应性增生64个,超声弹性应变率在乳腺癌腋窝淋巴结良恶性中的诊断的敏感度为90.7％,特异度为87.5％,准确度为90.6％。ROC曲线分析最合适的诊断临界点为2.07。结论 超声弹性应变率是一种鉴别转移性淋巴结与反应性增生的淋巴结的有效方法。     

Intraoperative, radio-guided sentinel lymph node mapping in laparoscopic lymph node dissection for Stage I testicular carcinoma

BACKGROUND: The management of regional lymph nodes in patients with clinical Stage I testicular carcinoma is a controversial problem. The authors investigated the feasibility and accuracy of radio-guided mapping of sentinel lymph nodes (SLNs) for men with clinical Stage I testicular tumors. METHODS: Twenty-two patients with clinical Stage I testicular carcinoma were enrolled in the study. One day before surgery, (99m)Technetium-labeled phytate was injected around the testicular tumor. After undergoing radical orchiectomy, patients underwent laparoscopic retroperitoneal lymph node dissection (L-RPLND). All radioactive lymph nodes were marked in the L-RPLND procedure, and three-dimensional SLN maps were made. All resected lymph nodes were evaluated by routine histopathologic examination, and the clinical significance of intraoperative SLN mapping was evaluated. RESULTS: SLNs were detected in 21 of 22 patients (95%). Nearly all SLNs were detected at the ventral or lateral side of the vena cava or at the aorta between the levels of the aortic bifurcation. All SLNs were detected easily in a surgical procedure. Only 1 radio-positive area per patient was identified in 15 patients, and approximately 2-4 positive areas were detected in 6 patients. Two patients had micrometastasis only in SLNs. In 2 patients who had seminoma, lymph node recurrences (at the level of the renal vein and in the obturator lymph node area) occurred at 10 months and 20 months after surgery. CONCLUSIONS: Radio-guided mapping of SLNs with laparoscopy was feasible, and nearly all SLNs were detected accurately by the procedure. In the near future, the standard retroperitoneal lymph node dissection may be avoided in most patients with clinical Stage I testicular carcinoma by utilizing focused examination of SLNs.