Luminal A型乳腺癌临床病理学及超声特征与腋窝淋巴结转移的关联分析

目的：探讨Luminal A型乳腺癌临床病理学及超声特征与腋窝淋巴结转移的关系。方法：研究对象为2016年1月—2022年10月南京医科大学第一附属医院收治的301例Luminal A型乳腺癌女性患者,其中82例为淋巴结转移组,219例为未转移组。采用单因素及多因素logistic回归分析患者临床病理学资料、肿块及腋窝淋巴结超声图像特征与腋窝淋巴结转移的相关性。结果：单因素分析结果显示,超声图像中肿块大小、形态、边缘及腋窝淋巴结超声图像中短径、长径/短径（L/S<2）、淋巴门结构消失、皮质厚度（>3 mm）、血供类型（非淋巴门型）及血流（丰富）差异有统计学意义,与淋巴结转移具有相关性（P<0.05）;多因素logistic回归分析,超声图像中的肿块大小（OR=1.842,P=0.016）、淋巴结皮质厚度（OR=2.649,P=0.036）、L/S(OR=0.354,P=0.007)及淋巴结血流（OR=2.255,P=0.039）是Luminal A型乳腺癌腋窝淋巴结转移的独立影响因素。结论：Luminal A型乳腺癌患者临床病理学及超声特征可以预测腋窝淋巴结转移,为临...     

早期乳腺癌无创腋窝淋巴结分期的临床初步观察

目的：探讨超声检查评估乳腺癌腋窝淋巴结转移状态的临床应用价值。方法入组军事医学科学院附属医院2013年12月至2015年9月期间连续收治的282例新发 Tis-T2期乳腺癌患者,指定2名高年资超声医师行腋窝超声检查,根据淋巴结声像学参数,将患者分为转移组、未转移组或可疑组。腋窝淋巴结分期以病理学结果作为金标准,分析超声检查评估乳腺癌腋窝淋巴结转移的准确性,比较各组腋窝淋巴结转移负荷;单因素及多因素Logistic 回归分析各个声像学参数对判断腋窝淋巴结转移状态的预测价值。结果超声判断腋窝淋巴结转移组＋未转移组的灵敏度、特异度、阳性及阴性预测值、准确度分别为85．6％、87．1％、86．4％、86．3％和86．3％,Kappa 值为0．727（P ＜0．001）。在病理证实腋窝淋巴结转移患者中,超声判断未转移组的平均淋巴结转移负荷明显低于超声转移组（1．2／6．9枚,P ＜0．001）,超声判断为未转移而病理结果证实为转移的患者共16例,其中14例患者腋窝淋巴结转移负荷仅为1枚,其余2例患者分别为2枚和3枚。单因素 Logistic 回归分析显示,最大皮质厚度预测腋窝淋巴结转移诊断效能最佳（ROC 曲线下面积为0．872）;多因素 Logistic 回归分析显示,最大皮质厚度、髓质与皮质厚度比值与腋窝淋巴结转移相关（P ＜0．05）。多因素 Logistic 回归模型 ROC 曲线下面积为0．879,灵敏度及特异度分别为77．0％和85．1％。结论超声检查评估腋窝淋巴结转移具有较高的准确性;超声判断假阴性的患者腋窝淋巴结转移负荷较低。最大皮质厚度是判断腋窝淋巴结转移最主要的声像学参数。在早期乳腺癌患者中,超声检查无创评估可能是潜在的替代前哨淋巴结活检行腋窝淋巴结分期的手段。     

乳腺癌MRI影像特征预测腋窝淋巴结转移的价值研究

目的 基于乳腺癌MRI特征建立可以无创性预测腋窝淋巴结转移(ALNM)的诺模图。方法 选取2013年8月～2020年8月于青岛大学附属医院放射科病理证实的乳腺癌患者394例,均行MRI检查并在1个月内获得淋巴结病理结果。根据乳腺影像报告和数据系统(BI-RADS)标准描述病变的MRI表现,分析乳腺癌原发肿瘤的MRI特征与腋窝淋巴结转移的关系并建立诺模图。结果 乳腺癌原发肿瘤的最大径及ADC值与腋窝淋巴结转移之间存在相关性,其次,与腋窝淋巴结转移相关的特征还有肿瘤位置、肿瘤边缘及肿瘤形状(P <0.05),多因素二元logistic回归后纳入肿瘤最大径、ADC值、肿瘤形状及腋窝有无可疑淋巴结建立对淋巴结预测的诺模图AUC值为0.890。结论 基于乳腺癌MRI特征的诺模图可以预测ALNM。这种非侵入性的方法在临床应用上很有前景。     

超声对乳腺癌腋下淋巴结良恶性的诊断价值

目的：探讨高频彩色多普勒超声对乳腺癌腋下淋巴结转侈诊断的价值。方法：回顾性分析了72例经超声检查并手术病理证实的乳腺癌患者的腋下淋巴结，观察乳腺癌患者双侧腋下淋巴结的大小，形态、数目、内部回声（皮质、淋巴门）、内部血流信号。结果：72例乳腺癌中，手术病理证实有淋巴结转移者31例，无淋巴结转移者41例。良性淋巴结的超声表现长径、短径大于1．5，最大皮质厚度小于3mm，血流分布为无血流型或门型。转移性淋巴结表现为圆形，形态不规则，长境径小于2，最大皮质厚度大于3mm，血流分布为周围型或混合型。结论：高频彩色多普勒超声是诊断乳腺癌淋巴结转移的一种简便、有效的检查方法。     

能量多普勒检测乳腺癌血流分布及其与腋窝淋巴结转移的关系

目的:研究乳腺癌的血流分布特点及其与腋窝淋巴结转移的关系。方法:通过能量多普勒(PDI)检测251例乳腺癌肿块内血流信号,结合波谱分析其与腋窝淋巴结转移的关系。结果:有淋巴结转移组乳腺癌肿瘤血供明显丰富,且最大血流峰值(PSV)和阻力指数(RI)较高(P<0.05)。结论:乳腺癌肿瘤血流分布情况与腋窝淋巴结的转移有很大的相关性。     

食管癌临床及超声特征与下颈部淋巴结转移的危险因素分析

【摘要】目的:探讨根据食管癌临床及超声特征确定下颈部淋巴结转移（LNM）的危险因素。方法:根据纳排标准搜集在我院行手术治疗的72例食管癌患者，行超声内镜检查并确定患者肿瘤位置、病变位置、浸润深度、病变处黏膜结构以及附近淋巴结情况。根据下颈部超声扫描结果分析各临床特征与下颈部LNM的相关性，确定下颈部LNM分区情况，并采用二元logistic回归分析确定下颈部淋巴结转移的危险因素。结果:超声检查结果显示，72例食管癌患者中27例发生了下颈部淋巴结转移，检出转移淋巴结共112枚。根据患者临床特征与是否发生LNM进行相关性分析,结果显示肿瘤分期、病变长度及淋巴结个数与LNM相关（P均＜0.05）。LNM分区主要位于II和III亚区，但其分布差异无统计学意义（P＞0.05）。logistic回归分析结果显示肿瘤分期、病变长度及淋巴结个数属于下颈部发生LNM的危险因素（P均＜0.05） 。结论:肿瘤分期、病变长度及淋巴结数目为食管癌患者发生下颈部LNM的危险因素，对于食管癌的临床诊断和治疗具有重要意义。     

超声特征联合临床病理指标构建列线图预测T1期乳腺癌腋窝淋巴结转移

【摘要】目的：建立联合原发病灶超声特征及临床病理指标预测T1期乳腺癌腋窝淋巴结转移风险的列线图并验证其临床价值。方法：回顾性分析2016年1月至2022年5月于石河子大学第一附属医院行手术及腋窝淋巴结清扫的536例T1期乳腺癌患者的超声资料及临床病理资料。通过单因素和多因素Logistic回归分析筛选出独立危险因素并制作列线图模型。运用ROC曲线、一致性指数、校准曲线验证列线图模型的区分度和一致性,决策曲线分析评估列线图模型的预测效能并使用Bootstrap重采样对模型进行内部验证。结果：多因素Logistic分析结果显示T1期乳腺癌肿块纵横比、Adler血流分级、T分期及HER-2表达状态是预测腋窝淋巴结转移的危险因素。基于以上4个指标构建列线图预测模型,其一致性指数为0.750（95%CI:0.704~0.796）。校准曲线、临床决策曲线分别提示模型一致性和临床应用效能良好。结论：联合原发病灶超声特征及临床病理指标所构建的列线图可有效预测T1期乳腺癌患者腋窝淋巴结转移风险,有助于为临床诊断、后期治疗及预后评估提供参考信息。     

超声联合肿瘤标志物诊断乳腺癌腋窝淋巴结转移的临床价值分析

目的分析乳腺癌患者术前超声检查联合角蛋白19(CK19)、癌胚抗原(CEA)检测诊断腋窝淋巴结转移的临床价值。方法回顾性分析2018年9月-2019年8月于郑州大学第五附属医院行乳腺癌改良根治术治疗的68例患者的临床资料,以病理诊断结果为金标准,将患者分为腋窝淋巴结转移组(n=38)与腋窝淋巴结未转移组(n=30),分析乳腺癌患者术前乳腺超声检查、CK19及CEA检测结果与腋窝淋巴结转移的关系,以及三者联合诊断腋窝淋巴结转移的临床价值。结果乳腺超声检查结果显示,腋窝淋巴结转移组患者淋巴结长径≥7 mm、边界不清、内部回声不均匀、淋巴结内血流信号丰富、纵横径之比<2等的检出率均高于腋窝淋巴结未转移组,差异有统计学意义(P<0.05)。腋窝淋巴结转移组患者血清CK19、CEA水平及阳性率均高于腋窝淋巴结未转移组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,CK19、CEA联合检测诊断腋窝淋巴结转移的ROC曲线下面积(AUC)为0.919,明显大于CK19(AUC=0.859)和CEA(AUC=0.849)单项检测,建立logistic回归模型:Logit(P...     

甲状腺癌颈部淋巴结转移的超声表现及对临床治疗的意义

目的:分析甲状腺癌颈部淋巴结转移的超声表现,探讨转移淋巴结的声像图特征、分布及对临床治疗的指导意义。方法:回顾性分析50例甲状腺癌患者126枚颈部转移淋巴结的超声表现及分布,所有病灶均经手术或超声引导下穿刺活检证实。分析转移淋巴结的长短径比值、边界、皮质厚度、淋巴门、内部囊性变、内部钙化、Adler血流分级、峰值流速(peak systolic velocity,PSV)、RI,并与40枚反应增生性淋巴结对比。结果:转移淋巴结长短径比值较小、边界欠清、皮质增厚、淋巴门高回声消失、内部可见囊性变及钙化、Adler血流分级及PSV均较高,与反应增生性淋巴结相比差异有统计学意义。结论:甲状腺癌颈部淋巴结转移具有特征性超声表现,其准确诊断及定位有助于指导患者的治疗。     

乳腺癌肿块的超声征象与腋窝淋巴结转移的关系

目的探讨乳腺癌肿块的超声征象与腋窝淋巴结转移的关系。方法将2017年1月～2018年8月我院收治的185例乳腺癌肿块患者作为研究对象,患者经前哨淋巴结活检确诊120例腋窝淋巴结阳性,65例腋窝淋巴结阴性。采用乳腺超声检查检测患者乳腺癌肿块,分析乳腺癌肿块的超声征象与腋窝淋巴结转移的关系。结果腋窝淋巴结阳性乳腺癌患者超声征象高回声晕、边界欠清、血流信号丰富、合并微小钙化、肿块直径≥2cm检出率显著高于腋窝淋巴结阴性乳腺癌患者,比较具有统计学差异(P0.05);腋窝淋巴结阳性乳腺癌患者肿块最大直径[(2.93±0.65)cm]高于腋窝淋巴结阴性者[(1.85±0.32)cm],而其阻力指数(0.62±0.07)低于腋窝淋巴结阴性者(0.78±0.12),比较具有统计学差异(P0.05);肿块最大直径、高回声晕、血流信号、微小钙化、边界、阻力指数是乳腺癌肿块发生腋窝淋巴结转移的独立影响因素。结论乳腺癌肿块的超声征象表现与腋窝淋巴结转移具有相关性,有助于诊断和预测腋窝淋巴结转移情况,值得临床进一步研究和选择。     

小乳癌的数字化乳腺摄影与超声成像对比研究

目的探讨数字化乳腺摄影与彩色多普勒超声对小乳癌及腋淋巴结转移的诊断价值。方法60例≤2.0cm(包括未形成肿块的早期乳腺癌)乳腺结节的数字化影像和超声资料分别由影像和超声医师用双盲法分析,定性诊断,并与病理对照。结果60例中,乳腺癌36例,良性病变24例;发现腋淋巴结96个,45个有转移。数字化摄影和超声在诊断小乳癌的敏感性、准确性及腋淋巴结转移的敏感性方面,二者差异显著(P(0.05);对直径≤1.0cm的病灶,数字化摄影的准确性明显高于超声(P(0.05)。结论对小乳癌及其腋淋巴结的定性诊断方面,数字化摄影为首选,二者结合有利于发现更早期的乳腺癌。     

超声对恩度联合新辅助化疗治疗乳腺癌的疗效观察

目的：探讨彩色多普勒超声检查在恩度联合新辅助化疗治疗乳腺癌疗效评估中的价值。方法：分别于治疗前后应用彩色多普勒超声对38例乳腺癌的40个乳腺病灶及腋窝淋巴结进行观察及分析。结果：40个病灶中34个治疗有效,病灶内血流信号分级降低或血流消失;Vm ax值明显降低（P〈0.05）;化疗前发现异常淋巴结共32个,治疗后有28个缩小或消失,30个血流信号明显减少。超声评估原发肿瘤缓解的总有效率为85%（34/40）。结论：超声检查可为恩度联合新辅助化疗治疗乳腺癌提供简便、安全的疗效观察手段。     

彩色多普勒超声对良恶性乳腺肿瘤的研究

目的：探讨彩色多普勒超声（ColourDopplerUltrasonography．CDU）在判断乳腺肿物良恶性和腋淋巴结转移的价值。材料和方法：作者分析了58例乳腺实性肿物的彩色多普勒超声和临床怀疑乳腺癌且CDU为阳性的30例病人的腋淋巴结CDU扫查结果。结果：发现34例乳腺癌中26例CDU有阳性表现，而24例良性肿物则均无阳性结果。得出CDU对乳腺癌的敏感性为77％，特异性100％，阳性符合率100％，肿癌直径小于1cm和浸润性小叶癌的CDU阳性率最低。对照术后病理，10例腋淋巴结CDU阳性者均已有淋巴结浸润，另有4例已受累的淋巴结CDU为阴性。CDU对腋淋巴结受累敏感性为71％，特异性100％，阳性符合率100％。结论：CDU对乳腺肿物良恶性以及腋淋巴结转移的判断上有重要的应用价值。     

PET/CT与增强CT检测乳腺癌及其腋淋巴结转移的对照研究

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT显像与螺旋CT增强扫描检测乳腺癌及其腋淋巴结转移的临床价值。方法27例乳腺肿块患者于同日行^18F—FDG PET／CT显像与CT增强扫描。患者俯卧于乳腺专用泡沫垫上接受检查，前者图像由3位核医学科医师采用目测法结合半定量法进行诊断，后者图像由3位影像科医师分析诊断；最后与病理检查结果对照。结果27例患者PET／CT与增强CT均发现31个乳腺肿块，病理检查证实其中21个为乳腺癌，10个为良性病变；发现腋淋巴结91个，共有66个转移（1例有双侧腋淋巴结转移）；PET／CT显像检测乳腺癌原发灶的灵敏度为80．95％，特异性为90％，阳性预测值为94．44％；检测淋巴结转移的灵敏度为89．39％，特异性为88％，阳性预测值为95．16％。增强CT检测乳腺癌原发灶的灵敏度为90．48％，特异性为60％，阳性预测值为82．61％；检测淋巴结转移的灵敏度为86．36％，特异性为52％，阳性预测值为82．61％。^18F—FDG PET／CT和增强CT对腋淋巴结状态的诊断与病理检查结果的列联系数分别为0．64和0．37；两者对乳腺癌及其腋淋巴结转移的诊断特异性差异有显著性（P〈0．05）；对直径〈2cm的病灶，^18F—FDG PET／CT诊断准确性明显高于增强CT（P〈0．05）。结论^18F—FDG PET／CT对诊断乳腺癌及其腋淋巴结转移的特异性均高于增强CT。     

99Tcm-MIBI显像对乳腺癌腋窝转移淋巴结的诊断

目的 评价＾９９Ｔｃ＾ｍ－甲氧基异丁基异腈（ＭＩＢＩ）显像要诊断乳腺癌腋窝转移淋巴结中的价值,方法 １８例病理检查证实的乳腺癌病人,术前均行＾９９Ｔｃｍ－ＭＩＢＩ显像,１４例乳腺未触及肿块者作为对照组,静脉注射＾９９Ｔｃ＾ｍ－ＭＩＢＩ１１０ＭＢｑ后５,３０和６０ｍｉｎ进行早期及延迟显像,分别于左侧位,右侧位和前后位进行观察,患者均在显像扣１周内进行手术治疗,腋窝淋巴结清扫后行病理检查。结果 １８例     

Prediction of Axillary Lymph Node Status of Breast Cancer Patients by Tumorbiological Factors of the Primary Tumor

BACKGROUND AND PURPOSE: The increasing use of systemic adjuvant therapy even in lymph node-negative breast cancer patients and breast cancer screening programs detecting smaller tumors with less probability of metastatic lymph nodes questions the need for routine axillary lymph node dissection. Since morbidity of breast cancer surgery is predominantly related to axillary lymph node dissection, predictive models for lymph node involvement may provide a way to avoid lymph node surgery and its side effects in subgroups of patients. PATIENTS AND METHODS: Using a multivariate logistic regression model, tumorbiological parameters such as expression of estrogen and progesterone receptors, Ki-67, p53, cathepsin D, HER2, S-phase fraction, and ploidy were analyzed regarding their ability to predict axillary lymph node involvement in 655 breast cancer patients. RESULTS: The model correctly predicted axillary lymph node metastases in 58% of the patients by including expression of progesterone receptor, HER2, and Ki-67. In a subgroup of 200 patients predicted to be at extremely high or extremely low risk for axillary lymph node metastases, the accuracy of the prediction was 70%. CONCLUSION: With a model just based on tumorbiological parameters obtained in the primary tumor it is possible to predict axillary lymph node status. By including additional parameters it appears to be feasible to further improve the model in order to avoid axillary lymph node surgery in low-risk women.     

Patients with breast cancer: differences in color Doppler flow and gray-scale US features of benign and malignant axillary lymph nodes

PURPOSE: To document differences in color Doppler flow and gray-scale ultrasonographic (US) features between benign and malignant axillary lymph nodes in women with primary breast cancer. MATERIALS AND METHODS: The longitudinal-transverse axis ratio and hilar status on color Doppler flow and gray-scale US images were prospectively studied for each of 145 axillary nodes in 135 women (74 palpable nodes in 69 women, 71 nonpalpable nodes in 66 women) with primary breast cancer. Intranodal flow distribution was described as peripheral, central, or central perhilar. Resistive and pulsatility indexes and peak systolic velocity were documented. For comparison of benign and malignant features, nodes were divided into three groups: palpable and nonpalpable, palpable, and nonpalpable. RESULTS: Color flow was demonstrated equally well in benign and malignant axillary lymph nodes for all three groups. For all nodes, peripheral flow was significantly higher in malignant (118 of 153 nodes [77%]) than benign (45 of 160 nodes [28%]) nodes (P <.001); central flow and central perhilar flow were significantly greater (P <.002 and <.001, respectively) in benign than malignant nodes. Similar differences were not observed in nonpalpable nodes. The mean longitudinal-transverse axis ratio (+/- SD) was significantly lower in malignant (1.8 +/- 0.6) than benign (2.6 +/- 0.8) nodes. Logistic regression analysis showed peripheral, central, and central perhilar flow and the mean longitudinal-transverse axis ratio to be significant independent predictors of malignancy. CONCLUSION: Color Doppler flow and gray-scale US features applicable to the identification of disease in palpable axillary nodes in patients with breast cancer are not applicable to nonpalpable nodes.     

MR imaging-guided sonography followed by fine-needle aspiration cytology in occult carcinoma of the breast

OBJECTIVE: In patients with axillary metastases as clinical evidence of possible occult breast cancer, a combined approach of MR imaging, sonography, and aspiration biopsy cytology was evaluated. SUBJECTS AND METHODS: Thirty-one women with metastatic adenocarcinoma in their axillary lymph nodes originating from an unknown primary site underwent MR imaging of the breast because physical examination and mammography findings were normal. Twenty of the 31 women had no history of malignancy, 10 had been previously treated for contralateral breast cancer, and one patient had nodal metastases in the contralateral axilla at the time breast cancer was detected. When a contrast-enhancing lesion was revealed on MR imaging of the breast, sonography and fine-needle aspiration cytology were also performed. RESULTS: MR imaging revealed the primary breast cancer in eight (40%) of the 20 patients without a history of malignancy. MR imaging of the breast revealed a second primary cancer in three (27%) of the 11 patients with previous or simultaneous breast cancer. All lesions were identified with sonography and verified by cytology and histology. CONCLUSION: In women with axillary lymph node metastases from adenocarcinoma, MR imaging of the breast should be added to clinical examination and mammography before defining the breast cancer as occult. The combined approach of MR imaging, sonography, and aspiration fine-needle cytology is a good alternative to the MR imaging-guided biopsy.     

Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

OBJECTIVE: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. MATERIALS AND METHODS: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. RESULTS: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. CONCLUSION: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.     

99Tcm标记抗粘蛋白McAb乳腺癌放射免疫显像的临床研究

目的　评价99Tcm 标记抗乳腺癌粘蛋白单克隆抗体 (McAb)放射免疫显像 (RII)诊断乳腺癌的临床价值。方法　选择 17例乳腺肿瘤患者进行RII。结果　 9例原发性乳腺癌中 8例RII阳性 ,灵敏度 88 89% ;5例原发性乳腺癌伴腋淋巴结转移及 1例右乳腺浸润性导管癌根治术 5a后出现右腋淋巴结转移 ,RII发现其中 5例出现淋巴结转移 ;而 6例乳腺良性病变和 1例右乳腺单纯癌根治术7a后随访 ,RII阴性。结论　99Tcm 标记抗粘蛋白McAbRII可作为乳腺癌特异性诊断的重要辅助手段 ,并对淋巴结转移、术后复发等具有一定的诊断价值。