前哨淋巴结显像研究

前哨淋巴结系指原发肿瘤淋巴引流的第一级淋巴结，淋巴显像可准确定位前哨淋巴结及其数目，检出率达80%-100%，常用的前哨淋巴结显像剂有^99Tc^m-硫胶体，^99Tc^m-人血清白蛋白，^99Tc^m-右旋糖酐等，该法简便安全，实用性强，已先后应用于黑色素瘤，乳腺癌，妇科肿瘤等疾病的术前常规定位诊断，取得了很好的结果。     

经皮超声造影对乳腺癌前哨淋巴结的定性评估

目的探讨经皮超声造影(CEUS)对乳腺癌术前前哨淋巴结(SLN)的定性诊断价值。资料与方法回顾性分析103例乳腺癌患者术前经皮下CEUS识别并行术中前哨淋巴结活检(SLNB)的146枚SLN的增强模式。将增强模式分为4型:Ⅰ型,完全均匀增强型;Ⅱ型,周边及髓质均匀增强型;Ⅲ型,周边和(或)髓质不均匀增强型;Ⅳ型,完全无增强型。分析良性与转移性SLN的增强模式特点,评估增强模式对SLN的诊断效能。结果146枚SLN中,良性102枚,转移性44枚。Ⅰ型增强模式100.0%(58/58)为良性,Ⅱ型87.1%(27/31)为良性,Ⅲ型59.5%(22/37)为转移性,Ⅳ型90.0%(18/20)为转移性。SLN的增强模式与其病理性质有关(rs=0.704,P<0.05)。经皮CEUS诊断SLN性质的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为90.9%、83.3%、70.2%、95.5%、85.6%。结论经皮CEUS对乳腺癌术前SLN的定性评估具有较高的诊断价值。     

CEUS联合声触诊组织成像定量检测兔VX2乳腺癌转移前哨淋巴结

目的探讨超声造影(CEUS)联合声触诊组织成像定量(VTIQ)对荷瘤兔乳腺癌转移前哨淋巴结(SLN)的诊断价值。方法建立24只兔VX2乳腺癌模型,建模2～3周后对其行CEUS、VTIQ以及联合两种诊断方法,检测腋窝淋巴结是否存在转移,比较3种方法对SLN的检出率,评价诊断效能。结果 CEUS、VTIQ及CEUS联合VTIQ三种方法对SLN的检出率分别为84.38%(27/32)、75%(24/32)、90.63%(29/32),差异无统计学意义(P0.05)。CEUS诊断转移性SLN(MSLN)的敏感度、特异度、准确率分别为70%、71.43%、70.37%,VTIQ诊断MSLN的敏感度、特异度、准确率分别为64.71%、85.71%、70.83%,CEUS联合VTIQ诊断MSLN的敏感度、特异度、准确率分别为95.45%、71.43%、89.66%,三种检查方法的敏感度差异有统计学意义(P0.05)。结论 CEUS联合VTIQ有助于提高诊断MSLN的灵敏度。     

FDG PET/CT联合99Tcm-SC前哨淋巴结显像诊断乳腺癌

^99Tc^m-硫胶体(SC)乳腺前哨淋巴结(SLN)显像是判断乳腺癌第1站淋巴结是否有转移的一种方法，对乳腺癌治疗方案的设计具有一定的指导作用；而^18F-脱氧葡萄糖(FDG)PET／CT显像则从乳腺癌原发病灶及其转移淋巴结的异常代谢结合形态方面进行诊断。本研究联合以上两种方法对部分乳腺癌患者进行研究，现报道如下。     

前哨淋巴结显像研究

前哨淋巴结系指原发肿瘤淋巴引流的第一级淋巴结,淋巴显像可准确定位前哨淋巴结及其数目,检出率达80%~100%。常用的前哨淋巴结显像剂有99Tcm-硫胶体、99Tcm-人血清白蛋白、99Tcm-右旋糖酐等。该法简便安全、实用性强,已先后应用于黑色素瘤、乳腺癌、妇科肿瘤等疾病的术前常规定位诊断,取得了很好的结果。     

99Tcm-硫胶体及其联合染色法对早期乳腺癌前哨淋巴结探测的比较

目的 评价单用99Tcm-硫胶体和99Tcm-硫胶体与亚甲蓝联合应用探测早期乳腺癌前哨淋巴结(SLN)的效能.方法 76例早期乳腺癌患者分为单用99Tcm-硫胶体组(25例)和99Tcm-硫胶体与亚甲蓝联合组(51例),分别在术前进行乳腺癌SLN探测,以腋窝淋巴结病理检查结果作为评价标准.结果 76例患者中成功探测到S...     

经皮注射淋巴结超声造影与常规超声对乳腺癌前哨淋巴结的诊断价值比较

目的:探讨超声造影与常规超声检测乳腺癌前哨淋巴结(SLN)的价值差异。材料和方法:以术中亚甲蓝染色为对照,采用经皮注射声诺维对22例乳腺癌患者同侧腋窝的前哨淋巴结进行造影检查,根据造影增强特点与常规超声检查结果进行淋巴结性质的比较。结果:22例患者中术前超声造影成功检出前哨淋巴结32枚,以术中亚甲蓝染色检出35枚为标准,超声造影的敏感性为91%。常规超声发现淋巴结24枚,比较超声造影及常规超声判断淋巴结性质的敏感性、特异性、准确性,超声造影较常规超声有了提高,但两者之间无统计学意义(P>0.05)。结论:经皮注射声诺维不仅可定位前哨淋巴结,还可判定性质,较常规超声更有价值。     

乳腺癌前哨淋巴结的探测

目的　评价生物染料、99Tcm 硫胶体及 2种方法联合探测前哨淋巴结 (SLN)的临床效果。方法　 71例早期乳腺癌患者 ,年龄 (5 5 .18± 11.79,34～ 85 )岁 ,采用生物染料 (亚甲蓝、isosulfanblue)、99Tcm 硫胶体及联合探测。以手术切除后淋巴结病理检查作为评价标准。结果　 71例患者中6 0例定位成功。亚甲蓝组探测SLN的检出率、准确性、灵敏度和假阴性率分别为 75 0 % ,83 3% ,70 0 %和 30 0 % ;isosulfanblue组分别为 86 2 % ,96 0 % ,90 0 %和 10 0 % ;99Tcm 硫胶体组 8例中检出SLN 7例 ,真阳性、假阴性和真阴性分别为 1,0和 6例 ;99Tcm 硫胶体 +isosulfanblue组 10例均检出SLN ,真阳性、假阴性及真阴性分别为 3,0和 7例。结论　SLN探测可较准确地反映腋淋巴结的组织学特点 ,染料和99Tcm 硫胶体联合应用可提高SLN检出率、准确性和灵敏度 ,降低假阴性率。     

超声引导下淋巴结经皮穿刺活检对颈部肿大淋巴结的诊断价值

目的 :探讨超声引导下淋巴结经皮穿刺活检术(percutafleous needle core biopsy,PNCB)对颈部肿大淋巴结诊断的应用价值。方法:选择104例颈部淋巴结肿大的患者,对其行常规超声检查、PNCB病理诊断及手术切除淋巴结病理诊断。统计进针次数、成功率、PNCB取材效果,并评价结果。将手术切除标本病理学检查结果为金标准,分为恶性(阳性)与良性(阴性),采用ROC分析方法计算常规超声与PNCB病理诊断的敏感度、特异度、阳性预测值、阴性预测值及准确率。结果 :104例均进针3~6次,共穿刺415针,其中386针适合进行病理学检查,成功率93.01%。415针穿刺取材效果评价分4级结果为:优202针,良141针,一般43针,差29针;术后病理学诊断显示,颈部淋巴结结核31例,炎性增生淋巴结5例,恶性淋巴瘤16例,转移或浸润癌52例。PNCB病理诊断除1例将转移癌诊断为炎性增生淋巴结外,其余病理诊断与术后病理学诊断一致;常规超声诊断敏感度97.06%、特异度75.00%、阳性预测值88.00%、阴性预测值93.10%、准确率89.42%,PNCB的病理诊断的敏感度98.53%、特异度100%、阳性预测值100%、阴性预测值97.36%、准确率99.04%。结论 :PNCB诊断颈部肿大淋巴结安全、易操作,且标本满意率及病理诊断准确性高,值得临床推广。     

超声造影在诊断乳腺癌肝转移中的应用价值

目的:探讨超声造影(CEUS)在诊断乳腺癌肝转移中的应用价值。材料和方法:对89例常规超声疑似乳腺癌肝转移者行CEUS和增强CT(CECT)后,采用穿刺活检、手术病理、影像学随访超过半年临床最后确诊。结果:89例常规超声疑似乳腺癌肝转移经CEUS及相关检查临床最后确诊为良性41例。48例乳腺癌肝转移经CEUS明确诊断47例。CEUS对乳腺癌肝转移诊断的敏感度为97.92%(47/48),假阴性率为2.08%(1/48),特异度为100%(41/41),阳性预测值为100%(47/47),阴性预测值为97.62%(41/42)。经CEUS发现新增转移病灶10例。CEUS从常规超声53.93%(48/89)的诊断准确度提高到98.88%(88/89)。CEUS对乳腺癌肝转移的诊断率与CECT在统计学上无差异(P=0.833)。结论:CEUS能发现乳腺癌较小的肝转移灶,提高了超声诊断乳腺癌肝转移的鉴别能力和准确度。     

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。     

超声多参数回归模型评估乳腺癌腋窝淋巴结转移的价值

目的：建立以乳腺癌腋窝淋巴结超声诊断特征为变量的Logistic回归模型,评价常规超声及实时弹性成像技术对乳腺癌腋窝淋巴结有无转移鉴别诊断的价值。方法对病理证实的112例乳腺癌患者的113个腋窝淋巴结的常规超声及弹性成像各因素进行综合分析,建立二分类Logistic回归模型,通过绘制ROC曲线评价模型的诊断效能。结果在纳入的113个淋巴结中,术后病理证实28个无转移,85个有转移。经过前进法Logistic回归分析,筛选出弹性应变率比值（ SR）、弹性评分及形态等3个指标对乳腺癌腋窝淋巴结转移诊断有统计学意义的特征变量。 Logistic回归模型对乳腺癌腋窝淋巴结转移预报的正确率为93．8％, ROC曲线下面积为0．962。结论二分类Logistic回归模型对腋窝淋巴结性质有较好的诊断效能,弹性成像提高了常规超声诊断腋窝淋巴结的准确度。     

乳腔镜下应用核素联合染料示踪法对新辅助化疗后乳腺癌患者行前哨淋巴结活检的研究(附41例报告)

目的 在乳腔镜下采用核素联合染料示踪法对新辅助化疗后的乳腺癌患者行前哨淋巴结活检(SLNB),探讨通过前哨淋巴结(SLN)对腋窝淋巴结内癌细胞转移情况进行预测的可行性.方法 选择行新辅助化疗2～4个疗程后的乳腺癌患者41例,术前15～18h在肿块或活检腔周围分4点注射~(99)Tc~m标记的硫胶体0.5～1.0mCi(1Ci=3.7×10~(10)Bq),术中在同样部化皮下注射美蓝4～6ml.使用γ探测仪在存在高放射活性的部位进行体表定位,腋窝注射溶脂剂,吸脂后,乳腔镜下行SLNB,然后行腋窝淋巴结清扫.将检出的淋巴结制成石蜡切片行常规病理检查,将结果显示有癌细胞转移的淋巴结确定为转移阳性;对病理检查显示为转移阴性的SLN进一步采用免疫组化法检测CK19的表达.计算采用SLN进行预测的准确率、敏感性、特异性、假阴性率和假阳性率.结果 41例患者中,39例患者(95.12%)检出SLN,共126枚,每例平均3.07(1～5)枚.病理检查显示,18例患者的SLN转移阳性(均为真阳性),21例SLN转移阴性(其中20例为真阴性,1例为假阴性).SLN对腋窝淋巴结内癌细胞转移情况的预测准确性为97.43%,敏感性为94.74%,特异性100%,假阴性率为5.26%,假阳性率0%.免疫组化法检测显示,1例病理检查显示转移阴性的SLN内CK19表达阳性.所有患者均对SLNB术后的美容效果较为满意.结论 乳腔镜下应用核素联合染料示踪法能提高SLN的检出率,且具有微创、美容的优点.通过SLN内癌细胞转移情况能够较为准确地预测新辅助化疗后乳腺癌患者腋窝淋巴结内癌细胞的转移情况.     

Application of conventional ultrasonography combined with contrast-enhanced ultrasonography in the axillary lymph nodes and evaluation of the efficacy of neoadjuvant chemotherapy in breast cancer patients

Objective:Axillary lymph node status assessment has always been an important issue in clinical treatment of breast cancer. However, there has been no effective method to accurately predict the pathological complete response (pCR) of axillary lymph node after neoadjuvant chemotherapy (NAC). The objective of our study was to investigate whether conventional ultrasonography combined with contrast-enhanced ultrasonography (CEUS) can be used to evaluate axillary lymph node status of breast cancer patients after NAC.Methods:A total of 74 patients who underwent NAC were recruited for the present study. Prior to and after NAC, examinations of conventional ultrasonography and CEUS were performed. After evaluating the images of conventional ultrasonography, four characteristics were recorded: lymph node medulla boundary, cortex of lymph node, lymph node hilus, and lymph node aspect ratio. Two additional imaging characteristics of CEUS were analyzed: CEUS way and CEUS pattern. Receiver operating characteristiccurve analysis was applied to evaluate their diagnostic performance.Results:After 6~8 cycles of NAC, 46 (71.9%) patients had negative axillary lymph node, and 18 (28.1%) patients turned out non-pCR. According to statistical analysis, lymph node medulla, lymph node aspect ratio and CEUS way were independently associated with pCR of axillary lymph node after NAC. The area under the curve of the prediction model with three imaging characteristics was 0.882 (95% confidence interval: 0.608–0.958), and the accuracy to predict the patients’ lymph node status was 78.1% (p < 0.01).Conclusions:Conventional ultrasonography combined with CEUS technology can accurately predict axillary lymph nodes status of breast cancer patients after NAC.Advances in knowledge:The usefulness of CEUS technology in predicting pCR after neoadjuvant chemotherapy is highlighted.     

超声造影结合Bosniak标准在良恶性肾囊性病变鉴别诊断中的价值

目的 评价超声造影鉴别良恶性肾囊性病变的准确性,探讨超声造影结合Bosniak标准分级诊断肾囊性病变的可行性.资料与方法 对30例患者的36个肾囊性病灶进行超声造影,分析良恶性肾囊性病变的超声造影征象;按照Bosniak标准对超声造影的表现进行分级诊断,计算其敏感性、特异性、诊断符合率、阳性预测值、阳性似然比、Kappa值及验后概率,分析该方法分级诊断肾囊性病变的准确性.结果 超声造影可显示常规超声不能发现的囊内分隔及实性结构.超声造影结合Bosniak标准诊断肾囊性病变的敏感性、特异性、诊断符合率、阳性预测值、阳性似然比分别为92.9％、90.9％、94.8％、86.7％、10.2,Kappa=0.83;应用超声造影结合Bosniak标准可提高肾囊性病变良恶性诊断的验后概率.结论 超声造影结合Bosniak标准可以提高鉴别诊断肾囊性病变良恶性的准确性.     

探测乳腺癌前哨淋巴结的初步应用

目的 评价核素淋巴显像和γ探针定位确定乳腺癌前哨淋巴结（SLN）的价值。方法 28例妇性乳腺癌患者,体检腋窝未扪及肿块。^99Tc^m－右旋糖酐（Dx）37MBq皮下注射,行淋巴显像后用γ探针皮肤定位,并与手术、病理检查结果对照。结果 28例患者中活检的SLN26例,灵敏度为85.7%(6/7例）,特异性100％（19／19例）。结论 核素淋巴显像和γ探针定位是一种简便、安全、易被患者接受的检测SLN的方法,对预测腋窝淋巴结转移有很大帮助。     

Preliminary study of real-time three-dimensional contrast-enhanced ultrasound of sentinel lymph nodes in breast cancer

To investigate the clinical value of real-time three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the detection of sentinel lymph nodes (SLNs) and drainage lymphatics in breast cancer patients. The prospective study was performed in women with pathology-confirmed T1/2 breast cancer between June 2016 and December 2017 who underwent sentinel lymph node biopsy and 3D-CEUS. The number, size, location, enhancement pattern of SLNs, and the lymphatic drainage patterns were reviewed. The routes, location of SLNs, and lymph channels (LCs) on the surface were marked. All patients underwent blue dye–guided sentinel lymph node biopsy (SLNB) finally. According to the postoperative pathology findings and the blue dye staining of the lymphatic drainage routes, there are six patterns of lymphatic drainage routes and the coincidence rate of the 3D-CEUS was 97.4%; the sensitivity, specificity, positive predictive value, negative predictive value, the LN detection rate, and the correct diagnosis rate of the 3D-CEUS were 75%, 93.0%, 81.8%, 89.9%, 95.3%, and 87.7%, respectively. 3D-CEUS is a new feasible and useful approach to detect the SLNs and LCs. 3D-CEUS can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes. • The three-dimensional contrast-enhanced ultrasound can detect the sentinel lymph nodes. • The three-dimensional contrast-enhanced ultrasound can show the stereo direction of sentinel lymph nodes and lymph drainage routes. • The three-dimensional contrast-enhanced ultrasound can accurately localize the LCs and SLNs and estimate the presence of metastatic lymph nodes.     

Radioguided sentinel node detection in breast cancer patients: comparison of 99mTc phytate and 99mTc rhenium colloid efficacy

BACKGROUND: Radioguided sentinel node biopsy (SNB) of breast cancer patients has become a standard method for detecting early stage breast cancer. However, no standard radiopharmaceutical exists. METHODS: 99mTc rhenium colloid or 99mTc phytate SNB was used to aid detection in breast cancer patients. For each radiopharmaceutical, 100 patients were examined. The following points were compared: (1) scintigraphic detection rate of axillary sentinel nodes (detectability and number when detectable) and internal mammary sentinel nodes; (2) the number of nodes detected scintigraphically and the number detected during surgery; (3) sensitivity, specificity, accuracy, negative predictive value, and positive predictive value for axillary sentinel nodes. RESULTS: Axillary sentinel nodes of patients were biopsied using either 99mTc rhenium or 99mTc phytate. The number of axillary nodes surgically removed from patients given 99mTc rhenium was 2.28+/-1.08 (mean+/-SD), and the number of axillary nodes surgically removed from patients given 99mTc phytate was 1.68+/-0.82. Some patients given 99mTc rhenium showed a spill-over of radioactivity from sentinel nodes. Concordance of scintigraphically detected nodes and surgical removed nodes was superior for 99mTc phytate compared to that with 99mTc rhenium, with a statistically significant difference. The sensitivity and negative predictive value was superior with 99mTc phytate compared to that with 99mTc rhenium, even though no statistical difference was detectable. However, visualization of internal mammary nodes was superior with 99mTc rhenium. CONCLUSION: In breast cancer patients, 99mTc phytate is a better choice for the detection of axillary SNB than 99mTc rhenium colloid. However, 99mTc rhenium colloid is a better choice for the detection of internal mammary nodes.