乳腺癌声像图中微钙化与肿瘤生物学行为关系的研究

目的探讨乳腺癌肿块声像图中微钙化与肿瘤生物学行为的关系。方法245例经手术或穿刺活检证实的乳腺癌患者270个肿块,选择肿块的大小、边缘、形态、淋巴结转移、组织学分级及人表皮细胞生长因子受体-2（C—erbB-2）表达6项反映乳腺癌生物学行为的指标,与肿块的微钙化情况分别进行相关性分析。结果乳腺癌患者微钙化灶与肿块的边缘、形态、淋巴结转移及C—erbB-2表达情况有明显的相关性（P〈0．05）;而与肿块的大小及组织学分级无相关性（P〉0．05）。结论乳腺癌肿块声像图中的微钙化能在一定程度上反映肿瘤侵袭性的特点。     

Axillary lymph node dissection in pT1 breast cancer: a retrospective analysis of 315 patients and review of the literature.

Axillary lymph node status and pathologic features of the primary tumor are used to predict the prognosis and select appropriate adjuvant therapy for individual patients with breast cancer. The goal of our study is to identify a group of breast cancer patients who would not benefit from axillary dissection. We researched medical literature and conducted retrospective analyses of 315 consecutive postmenopausal women with breast tumors under 2.0 cm in diameter (pT1) in relation to the extent of axillary lymph node involvement. None of the 39 patients with pT1a tumors had axillary lymph node metastases (ALNM). Of the remaining 276 patients, the ALNM rate in the subgroup pT1b and grading 1 was 5.9%. As expected, the frequency of positive lymph nodes increased the larger the tumor and the higher the grading. Our data corresponds with some of the literature reviewed, although the percentage of axillary involvement described, especially in the subgroup of pT1a tumors, varies within a wide range (0-28%). Our data indicates that it is unlikely that invasive breast cancer pT1a (< or = 0.5 cm) is associated with axillary lymph node metastases in women older than 50 years. The authors conclude that the parameter tumor size, combined with age, can help to assess the risk for axillary lymph node metastases.     

乳腺癌中EGFR和CXCR4的表达及其意义

[目的]研究EGFR和CXCR4在乳腺癌组织内的表达,探讨它们与乳腺癌组织学分级、局部淋巴结转移、肿瘤大小和病理类型的关系及其在乳腺癌发生过程中的作用.[方法]应用免疫组化（SP）法检测了76例乳腺癌标本EGFR和CXCR4的表达情况,分析了EGFR和CXCR4与乳腺癌组织学分级、局部淋巴结转移、肿块大小及病理类型的关系.所有患者术前均未进行过化疗、放疗和内分泌治疗.[结果]①EGFR在乳腺癌组织中阳性表达率为59.2%,EGFR表达与组织学分级,局部淋巴结转移和病理类型有显著相关性（P〈0.05）,与肿瘤大小无显著相关性（P〉0.05）;②CXCR4在乳腺癌组织中阳性表达率为56.6%, CXCR4表达与组织学分级,局部淋巴结转移和病理类型有显著相关性（P〈0.05）,与肿瘤大小无显著相关性（P〉0.05）;③EGFR、CXCR4在不同级别乳腺癌间的表达有显著性差异（P〈0.05）,两者随着乳腺癌组织学分级增高而表达增强（r=0.381,P〈0.01）.[结论]EGFR和CXCR4在乳腺癌内均有表达,且随着组织学分级的增高而增加,提示EGFR和CXCR4在乳腺癌的发生过程中可能起重要的作用.     

Transrectal ultrasound and computed tomography in preoperative staging of lower rectal adenocarcinoma

A comparison of transrectal ultrasound (TRUS) and computed tomography (CT) for staging of rectal carcinoma was performed. Thirty-two patients were examined by TRUS and 30 by CT. The results of these preoperative examinations were compared with postoperative histopathological findings. TRUS had an accuracy of 81% and it predicted perirectal tumor growth with a sensitivity of 90% and a specificity of 67%, whereas the corresponding figures for CT were 52%, 67%, and 27%. These findings indicate that TRUS is more efficient than CT in staging local tumor growth in rectal cancer. Neither technique, however, can reliably identify lymph node metastases, since no correlation was found between lymph node size as observed on CT and TRUS and tumor involvement as evaluated histopathologically.     

大范围MRI扩散加权成像在食管、贲门癌淋巴结微转移中的应用

目的 探讨大范围磁共振扩散加权成像对食管、贲门癌术前分级及淋巴结转移的效果.方法 35例食管癌术前行大范围MRI扩散加权成像,判定异常淋巴结数量及位置,与手术所见及术后病理结果对比.结果 大范围MRI扩散加权成像发现淋巴结转移23例,病理结果转移18例,大范围MRI弥散成像无淋巴结转移12例,病理结果无转移9例;大范围MRI扩散加权成像、病理结果欠符合7例,总符合率80%,锁骨上和纵隔淋巴结符合率达82.8%,腹部淋巴结符合率55.6%.结论 大范围MRI扩散加权成像对食管、贲门癌术前判断淋巴结转移较敏感,是食管、贲门癌术前评估淋巴结转移情况好方法,对直径<0.5 cm的淋巴结良恶性判定尚有不足.     

大范围MRI扩散加权成像在食管、贲门癌淋巴结微转移中的应用

目的 探讨大范围磁共振扩散加权成像对食管、贲门癌术前分级及淋巴结转移的效果.方法 35例食管癌术前行大范围MRI扩散加权成像,判定异常淋巴结数量及位置,与手术所见及术后病理结果对比.结果 大范围MRI扩散加权成像发现淋巴结转移23例,病理结果转移18例,大范围MRI弥散成像无淋巴结转移12例,病理结果无转移9例;大范围MRI扩散加权成像、病理结果欠符合7例,总符合率80%,锁骨上和纵隔淋巴结符合率达82.8%,腹部淋巴结符合率55.6%.结论 大范围MRI扩散加权成像对食管、贲门癌术前判断淋巴结转移较敏感,是食管、贲门癌术前评估淋巴结转移情况好方法,对直径<0.5 cm的淋巴结良恶性判定尚有不足.     

Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer.

OBJECTIVE: The aim of this study was to determine whether ultrasonography itself was able to distinguish benign from malignant lymphadenopathy in patients with thyroid cancer. METHODS: We evaluated lymph nodes in a group of patients with thyroid cancer. Nodes were detected and measured by ultrasonography, and their shape, echogenicity, size, and location were noted. Ultrasonographically guided fine-needle aspiration biopsy (FNAB) was performed, and smears were analyzed cytologically. RESULTS: Ultrasonographically guided FNAB was performed in 578 neck nodes in a group of 631 patients with thyroid cancer. In most cases, metastases had a round shape and various echo structures, with a predomination of hypoechoic nodes without a hilum. There were statistical differences in size between metastatic and benign nodes in terms of maximum diameter, minimum diameter, and volume. Among these, minimum diameter and the shape of the nodes seemed to be the most reliable in suggesting malignancy. A round shape with a longitudinal/transverse ratio of less than 2 of hypoechoic nodes indicated the presence of metastases, and we then performed FNAB. The absence of an echogenic hilum and the presence of cystic portions and calcifications were significantly greater in malignancies than in benign lesions (P<.001). In most cases, metastatic nodules were situated in the lower third of the neck. Reactively enlarged nodes occurred more frequently in the upper part of the neck. CONCLUSIONS: Ultrasonography itself cannot distinguish benign from malignant lesions, but an echographic appearance suggests malignancy and helps in the selection of the node to aspirate with ultrasonographically guided FNAB, which is crucial for a final diagnosis.     

Role of sentinel lymph node dissection in breast cancer

The sentinel node concept is valid for penile cancer, melanoma, breast cancer and is probably also applicable to other solid malignancies. Sentinel nodes are the one or two initial nodes in the regional nodal drainage basin encountered by the lymphatic effluent from a tumour, which can be identified with an injection of vital dye or other lymphogogue. Sentinel lymph node dissection (SLND), a minimally invasive procedure with negligible morbidity, has therefore been utilized as an alternative to complete axillary lymph node dissection (ALND) for staging breast cancer. Examination of sentinel nodes provides a focused histopathological assessment of tissue most likely to harbour metastases, providing enhanced staging accuracy with a low false-negative rate. Tumour-free sentinel nodes are predictive of a tumour-free axilla, thereby allowing for the possibility of SLND without ALND and sparing patients the morbidity of ALND. Most of the experience from SLND has been obtained for axillary sentinel nodes. However, sentinel nodes have been identified in nonaxillary sites, such as the internal mammary nodes, but data on SLND for these regions is scarce. The ultimate role of SLND in breast cancer, which may be to identify sentinel-node-negative patients or even those with sentinel node metastases who can safely avoid ALND without sacrificing regional control and possibly gain a therapeutic benefit, cannot be defined before we have the results of large trials that are currently in progress.     

乳腺叶状肿瘤的超声诊断

目的探讨乳腺叶状肿瘤的超声特征及超声对乳腺叶状肿瘤的术前诊断价值。方法回顾性分析经病理证实的15例18个乳腺叶状肿瘤的超声声像图特征,提出超声诊断要点。结果①本组乳腺叶肿瘤多见于中年女性。②所有肿物超声均表现为边界清晰的低回声肿物,病灶内部血流信号大多较丰富(14/18)。形态以分叶状较常见(13/18),内部可伴囊性变(6/18)。③本组病例未见腋窝淋巴结转移。结论乳腺叶状肿瘤的超声表现具有一些特征性,结合临床可提高乳腺叶状肿瘤的术前诊断水平。     

Follicular thyroid carcinoma with predominantly cystic formation presenting initially with multiple distant metastases

Primary malignancies presenting with multiple distant metastases include lung cancer, gastrointestinal malignancy, breast cancer, and prostatic cancer. Multiple distant metastases from follicular thyroid carcinoma (FTC) are uncommon. Cystic formation in FTC is an atypical finding in ultrasonography. The cystic formation of a thyroid nodule is usually considered a benign sonographic finding. We report the case of a 78-year-old man who presented with multiple distant metastases from an FTC with a predominantly cystic formation.     

大范围MRI扩散加权成像在食管、责门癌淋巴结微转移中的应用

目的探讨大范围磁共振扩散加权成像对食管、贲门癌术前分级及淋巴结转移的效果。方法35例食管癌术前行大范围MRI扩散加权成像,判定异常淋巴结数量及位置,与手术所见及术后病理结果对比。结果大范围MRI扩散加权成像发现淋巴结转移23例,病理结果转移18例,大范围MRI弥散成像无淋巴结转移12例,病理结果无转移9例;大范围MRI扩散加权成像、病理结果欠符合7例,总符合率80％,锁骨上和纵隔淋巴结符合率达82．8％,腹部淋巴结符合率55．6％。结论大范围MRI扩散加权成像对食管、贲门癌术前判断淋巴结转移较敏感,是食管、贲门癌术前评估淋巴结转移情况好方法,对直径〈0．5cm的淋巴结良恶性判定尚有不足。     

Evaluation of Axillary Lymph Nodes in Breast Cancer Patients with Atopic Dermatitis

This study assessed the diagnostic accuracy of ultrasound in detecting axillary lymph node metastases in women with breast cancer and atopic dermatitis. We retrospectively reviewed the records of 91 breast cancer patients with a history of atopic dermatitis and compared the dimensions of the lymph nodes on ultrasonographic images of women with and without lymph node metastases diagnosed using histology. Using a major-axis length of ≥5 mm, a short-axis length of ≥5 mm and a cortical thickness of ≥2.3 mm as the criteria for diagnosing axillary lymph node metastases, the specificity was 12.7%, 41.3% and 58.7%, respectively. The low specificity of the ultrasound criteria makes ultrasound unsuitable for diagnosing axillary lymph nodes metastases in breast cancer patients with atopic dermatitis.     

Benign breast lesions and subsequent breast carcinoma in Rochester, Minnesota.

Case histories of 444 female patients (Rochester residents) with benign breast disease pathologically diagnosed between 1935 and 1949 were studied prospectively for the development of breast cancer. After exclusion of unsuitable cases, 370 remained for review of pathologic diagnoses and statistical analysis. Breast cancer developed in 14 (3.8%) within a median period of 13.5 years after the diagnosis of benign breast disease. Most of these malignancies occurred within 10 years after the original diagnosis. Patients in whom the original diagnosis was chronic cystic mastitis developed breast cancer 2.9 times more frequently than expected. Breast cancer developed 10 times as often as expected in those patients of ages 40 to 49 at the time of diagnosis of breast malignancy. This evidence shows that a more intensive follow-up of patients with confirmed chronic cystic breast disease is justified, especially among those of ages 30 to 49 years.     

The role of ultrasound in the diagnosis of breast cancer.

Ultrasonography (US) of the breast is not applied to its optimal capacity if it is restricted to the differentiation between cystic and solid lesions and evaluation of dense breasts. It can play a major role in the detection of breast cancer; not only because of detection of mammographically occult lesions but also because of more accurate identification of lesion characteristics suspicious of malignancy. Its yield is highest among women younger than 50 years. However, one should keep in mind that the profit obtained by US shows not only the diagnostic accuracy of US but also that of mammography. Further improvement can be achieved by refinement in US diagnosis, especially with respect to the US characteristics of diffusely growing cancers.     

淋巴结转移指数与胃癌临床病理特征的相关性研究

目的探讨淋巴结转移指数与胃癌的临床病理特征的相关性,建立一个以淋巴结转移指数预测胃癌N分期的评分系统,为手术者选择合理的淋巴结切除范围提供一定帮助。方法回顾性分析216例胃癌患者的淋巴结转移和临床病理特征之间的相关性,单因素和多因素分析筛选出影响实际淋巴转移病理分期水平高低的临床参数,赋予各参数不同的计分分值。绘制接受者工作特征曲线,确定预测各淋巴结转移病理分期的评分标准。结果单因素分析显示不同肿瘤部位、大小、浸润深度、组织学类型的淋巴结转移病理分期差异具有统计学意义;早期胃癌与进展期胃癌淋巴结转移病理分期的差异具有统计学意义,但多因素分析结果显示肿瘤大小、浸润深度、组织学类型是淋巴结转移病理分期的独立影响因素。结论淋巴结转移指数能更加全面反映胃癌的淋巴结转移情况,是定义胃癌淋巴结转移病理分期的较好方法。     

Cancer-associated antigen CA 15-3 in the diagnostics of breast tumours

The serum concentration of the new marker CA 15-3 was determined by a kit method, which is based on the use of two different monoclonal antibodies 115D8 and DF3, in a coated tube immunoradiometric technique. The mean CA 15-3 values in breast cancer patients (n = 40) were significantly higher than in patients with benign breast disease (n = 52, p less than 0.001) and in control subjects (n = 32, p less than 0.001). When we used the cut-off level 35 kU/l for CA 15-3, 0/32 of control subjects, 1/52 (2%) of patients with benign breast disease, 8/40 (20%) of all breast cancer patients, 6/19 (32%) of breast cancer patients with axillary nodal involvement and 1/1 of breast cancer patients with distant metastases were above this level. Among the same patients the CEA serum test was positive at a cut-off level of 5 micrograms/l in 7/40 (18%) cancer cases, and in 6/19 (32%) of cancer patients with nodal involvement. When we used the cut-off level 35 kU/l for CA 15-3 and 5 micrograms/l for CEA 1/52 (2%) of patients with benign breast disease, 10/40 (25%) of all breast cancer patients, 7/19 (37%) patients with axillary nodal involvement and 1/1 of breast cancer patients with distant metastases were positive in one or both of the tests. The serum CA 15-3 and CEA values were higher in patients with tumour size above 2 cm in diameter than in patients with smaller tumours (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Pretreatment sonographic evaluation of inguinal lymph nodes in patients with vulvar malignancy

The state of the inguinal nodes is a major prognostic factor in vulvar carcinoma. Because of new surgical trends with selective inguinal lymphadenectomy, the preoperative evaluation of inguinal lymph nodes is essential for adequate treatment of vulvar carcinoma. To evaluate the adequacy of clinical examination and high-frequency transducer sonography in detecting metastatic inguinal lymph nodes, we studied 25 patients with vulvar malignancy who underwent operation. Histopathologically proved lymph node metastases were found in 11 (22%) of 50 inguinal areas studied. All of the suspected metastases were in patients with stage III-IV disease. The inguinal lymph node metastases were found by sonography in nine (82%), by preoperative palpation in one (9%), and by operative palpation in six (55%) of 11 areas. The difference between sonography and palpation was statistically significant (P < 0.01). The sensitivity and specificity were 82% and 87% for sonography, 9% and 100% for preoperative palpation, and 55% and 90% for operative palpation.     

乳腺癌分子分型与区域淋巴结转移的关系

目的：探讨乳腺癌分子分型与区域淋巴结转移之间的关系。方法采用回顾性方法,对经手术的312例乳腺癌患者临床、病理资料进行分析。结果312例乳腺癌患者中淋巴结阳性155例。312例患者乳腺癌分子分型：Luminal A型53例, Luminal B型91例,Luminal HER-2阳性型78例,HER-2阳性型55例,Basal-like型35例。单因素分析：年龄〈50岁与≥50岁, P=0.016;组织学III级与I-II级,P=0.023;原发肿瘤直径2~5cm与≤2cm ,P=0.001;HER-2阳性与阴性,P=0.009;Ki-67≥14%与〈14%,P=0.002;分子分型与区域淋巴结转移相关。由于分子分型与肿瘤大小显著相关（χ2检验,P〈0.01）,因此,多因素Logistic逐步回归分析,分子分型不是区域淋巴结转移的独立预测因子。结论乳腺癌分子分型对区域淋巴结转移的发生呈显著相关性,分子分型对乳腺癌的治疗决策具有重要意义。     

C-erbB-2表达、SPF和组蛋白酶D与乳腺癌预后

目的探讨乳腺癌病人的c-erbB-2表达,SPF与预后的关系,以及cath-D和临床病理特征关系.方法通过免疫组化法,检测128例乳腺癌病人的c-erbB-2和cath-D的表达.结果c-erbB-2表达比不表达病人预后差(P=0.01).cath-D和c-erbB-2表达与肿块大小、淋巴结转移显著相关(P＜0.0001).结论c-erbB-2阳性表达和cath-D阳性表达者,恶性程度高,易转移,预后差.