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.     

高频彩色多普勒超声早期诊断乳腺癌腋窝淋巴结转移的临床应用价值

目的 探讨应用高频彩色多普勒超声早期诊断乳腺癌腋窝淋巴结转移的临床应用价值.方法 选取拟实施乳腺癌根治手术的140例乳腺癌患者作为研究对象,所有患者术前均接受了乳腺及腋窝淋巴结高频彩色多普勒超声检查;选取其中77例经手术后病理学检查确诊为乳腺癌腋窝淋巴结转移的患者作为发生腋窝淋巴结转移组,余63例乳腺癌患者作为未发生腋窝淋巴结转移组.以术后病理学检查结果作为金标准,计算术前高频彩色多普勒超声诊断腋窝淋巴结转移的诊断学价值指标.结果 发生腋窝淋巴结转移组的皮质向心性增厚、淋巴结长短径之比、淋巴结内钙化灶、淋巴结的边界不清检出率均明显高于未发生腋窝淋巴结转移组,差异均有统计学意义(P﹤0.01);发生腋窝淋巴结转移组患者与未发生腋窝淋巴结转移组患者的血流分布和血流信号分级情况比较,差异均有统计学意义(P﹤0.01).其中,发生腋窝淋巴结转移组患者的血流分布主要以周边型为主(59.74%),血流信号分级主要为3级(71.43%);未发生腋窝淋巴结转移组患者的血流分布主要以门型为主(11.11%),血流信号分级主要为2级(71.43%);高频彩色多普勒超声早期诊断乳腺癌腋窝淋巴结转移的灵敏度为89.61%,特异度为82.54%,漏诊率为10.39%,误诊率为17.46%.结论 高频彩色多普勒超声对早期诊断乳腺癌腋窝淋巴结转移具有较高的临床实用价值.     

高频彩色多普勒超声对乳腺癌腋窝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窝淋巴结良恶性的诊断价值。方法 对200例乳腺癌患者均开展常规超声和高频彩色多普勒超声检查,将病理检查结果作为金标准,比较两种检查方法的诊断效能,并比较乳腺癌良恶性腋窝淋巴结的高频彩色多普勒超声声像特征、信号分布情况及血流分级。结果 病理检查结果显示,腋窝淋巴结良性患者120例,恶性患者80例。高频彩色多普勒超声诊断恶性腋窝淋巴结患者的灵敏度、特异度、阳性预测值、阴性预测值及准确度均高于常规超声。病理检查结果显示腋窝淋巴结共230枚,其中良性130枚,恶性100枚。恶性腋窝淋巴结皮质为偏心增厚、长短径比值≤2.0、融合、有钙化斑的比例均明显高于良性腋窝淋巴结,差异均有统计学意义（P﹤0.01）。恶性腋窝淋巴结信号分布为周边型及血流分级为Ⅲ级的比例均高于良性腋窝淋巴结,差异均有统计学意义（P﹤0.05）。结论 高频彩色多普勒超声诊断乳腺癌恶性腋窝淋巴结的灵敏度、特异度均较高,不仅能提高患者的诊断准确度,还能及时明确腋窝淋巴结的声像特征及血流信号分布情况,临床应用价值较高。     

高频彩色多普勒超声联合超声造影在乳腺癌腋下转移性淋巴结鉴别诊断中的应用

目的:探讨高频彩色多普勒超声联合超声造影对乳腺癌腋下转移性淋巴结鉴别诊断的价值.方法:收集2017年1月至2018年6月入住我院并经病理证实的女性乳腺癌患者87例,转移淋巴结患者45例,未转移患者42例,所有患者术前均行高频彩色多普超声检查和超声造影检查,对高频彩色多普超声检查和超声造影检查的诊断结果进行分析.结果:乳...     

超声弹性成像对乳腺癌腋窝淋巴结诊断价值的探讨

目的：腋窝淋巴结性质是影响乳腺癌预后的重要因素,也是临床选择治疗方式的重要依据。通过常规超声、超声弹性成像及二者联合的方法探讨诊断乳腺癌患者反应性淋巴结和转移性淋巴结的临床价值。方法选择2015-10-01－2016-04-30山东大学附属山东省肿瘤医院乳腺外科42例乳腺癌患者,共66个同侧腋窝淋巴结,应用常规超声、超声弹性成像评分法检查,与手术病理结果对照。结果在66个淋巴结中,反应性淋巴结34个,转移性淋巴结32个。常规超声反应性淋巴结得分1．12±0．98,转移性淋巴结得分2．53±1．37,差异有统计学意义,P ＜0．05。超声弹性成像反应性淋巴结得分2．21±0．64,转移性淋巴结得分3．13±0．66,差异有统计学意义,P ＜0．05。常规超声、超声弹性成像及二者联合的灵敏度分别为71．9％、84．4％和87．5％,特异度分别为76．5％、67．6％和52．9％,准确度分别为57．0％、58．1％和69．7％,三者受试者工作特征（receiver operating characteristic curve,ROC）曲线下面积分别为0．783、0．815和0．932,联合应用与常规超声比较差异有统计学意义,Z ＝2．28,P ＜0．05;联合应用与弹性成像比较,差异无统计学意义, Z ＝1．95,P ＞0．05;常规超声与弹性成像比较差异无统计学意义,Z ＝0．41,P ＞0．05。结论常规超声联合超声弹性成像有助于提高乳腺癌腋窝淋巴结性质的诊断效能。     

常规超声联合超声弹性成像在腋窝淋巴结定性诊断中的价值

目的:探讨超声评估乳腺癌腋窝淋巴结良恶性的临床价值。方法:对56例患者86个同侧腋窝肿大淋巴结行常规超声（conventional ultrasound,CUS）及超声弹性成像（ultrasound elastography,UE）检查,以超声引导下穿刺活检或术后病例检查结果为标准,将超声结果与病理诊断对照分析。结果:CUS+UE联合应用较单独应用CUS或UE诊断腋窝淋巴结良、恶性的敏感度、特异度、准确度均有较明显的提高,差异有统计学意义（P<0.05）。结论:超声对腋窝良恶性淋巴结的鉴别诊断具有重要价值。特别是联合应用UE,对于常规超声形态改变不明显的淋巴结性质判断有较大帮助。     

前哨淋巴结活检联合术前超声在老年乳腺癌腋窝淋巴结清扫中的价值

目的:探讨前哨淋巴结活检（SLNB）联合术前超声在老年乳腺癌患者治疗中的临床价值。方法:回顾性分析136例老年乳腺癌患者资料,将其分为三组,A组:SLNB+超声组,B组:SLNB组,C组:超声组。分别统计各组检查结果与术前腋窝淋巴结穿刺病理或SLNB的符合情况,分析三组对腋窝淋巴结转移的评价。结果:结果显示A组较B组、A组较C组均准确率高,差异有统计学意义,而B组与C组差异无统计学意义。诊断试验结果显示:SLNB比术前超声的特异度高,误诊率低。灵敏度和漏诊率差距不大。结论:SLNB联合术前超声在老年乳腺癌患者治疗中准确性高,较单独SLNB或术前超声均具有优势,值得在老年乳腺癌腋窝淋巴结转移情况的评估和治疗中推广应用。     

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。     

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     

The role of preoperative axillary ultrasound and fine-needle aspiration cytology in identifying patients with extensive axillary lymph node involvement

Introduction

In the recent past, both clinically node-positive and node-negative but sentinel node-positive patients underwent axillary lymph node dissection (ALND), although the two groups seem to have substantially different degree of nodal involvement.

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.     

乳腺癌超声特征与腋窝淋巴结转移相关性的研究进展

腋窝淋巴结状态影响着乳腺癌患者的治疗与预后,因此腋窝淋巴结的术前评估尤为重要。近年来许多研究发现,乳腺癌的常规超声、弹性成像及超声造影特征能够间接反映腋窝淋巴结的转移情况,可用于术前早期评估,避免不必要的前哨淋巴结活检。本文就乳腺癌超声特征与腋窝淋巴结转移间的相关性进行综述。     

超声对乳癌腋窝转移淋巴结的诊断价值

目的探讨超声对腋窝转移淋巴结的诊断价值和诊断标准.方法对经临床和病理确诊为乳癌腋窝淋巴结转移的初诊患者40例(共89个淋巴结),行腋窝肿块灰阶超声、彩色多普勒超声和多普勒能量图检查.结果本组转移淋巴结大小从0.5～3.5cm,85%以上的长短径之比＜2,内部回声主要为不均匀的低回声,淋巴结皮质不均匀增厚或消失,淋巴结门偏心或消失,边界模糊居多.血流分布主要为周边型(43.8%)和混合型(31.5%),RI值较高,为0.69.部分可见腋静脉受压.结论乳腺癌腋窝转移淋巴结的超声图像在形态、边缘、内部回声结构、血流分布、血流动力学及淋巴结包膜外转移等方面均有较为特征性的表现,根据二维灰阶超声和彩色多普勒超声检查结果,多可作出正确诊断.     

Clinical and pathologic factors predicting axillary lymph node involvement in breast cancer

The diagnosis of axillary disease remains a challenge in the management of breast cancer and is a subject of controversy. In 1998, the Japanese Breast Cancer Society conducted a study assessing axillary lymph node involvement in breast cancer. The study included (a) clinical assessment by pre-operative imaging modalities, (b) histologic assessment for peritumoral lymphatic invasion, (c) biologic assessment by gelatinolytic activity using film in situ zymography, and (d) sentinel lymph node (SLN) biopsy. Clinical assessments by CT, PET, and US as well as biologic assessment were limited in their ability to detect axillary lymph node disease, although these imaging techniques may be useful to exclude node-positive patients from the need for SLN biopsy. Histologic assessment for peritumoral lymphatic invasion was useful, particularly for detecting false-negative cases by SLN biopsy. Nevertheless, the utility of SLN biopsy in assessing axillary nodal status was confirmed. Axillary lymph node dissection (ALND) can be avoided in patients with a small tumor and a negative SLN. However, further studies will be required to investigate the value of SLN biopsy for predicting regional control and survival before it can replace routine ALND as the optimal staging procedure for operable breast cancer.     

Avoidance of axillary lymph node dissection in selected patients with node-positive breast cancer

Aims

Currently, it is standard practice to avoid ALND in patients with negative SLN, whereas this procedure is mandated for those with positive SLN. However, there has been some debate regarding the necessity of complete ALND in all patients with positive SLN. This review article discusses the issues related to eliminating the need for ALND in selected patients with positive nodes.

Methods

A review of the English language medical literature was performed using the MEDLINE database and cross-referencing major articles on the subject, focusing on the last 10 years.

Results

Currently, complete ALND is mandated in patients with SLN macrometastases as well as those with clinically positive nodes. It is not clear whether SLN biopsy is appropriate for axillary staging in patients with initially clinically positive nodes (N1) that become clinically node-negative (N0) after neoadjuvant chemotherapy. Although there is debate regarding whether ALND should be performed in patients with micrometastases in the SLN, it seems premature to abandon ALND in clinical practice. Moreover, it remains unclear whether it is appropriate to avoid complete ALND in patients with ITC-positive SLN alone.

Conclusions

In the absence of data from randomised trials, the long-term impact of SLN biopsy alone on axillary recurrence and survival rate in patients with SLN micrometastases as well as those with ITC-positive SLN remains uncertain. These important issues must be determined by careful analysis of the results of ongoing clinical trials.     

Clinical impact of false-negative sentinel lymph nodes in breast cancer

Aims

To evaluate the incidence of false-negative (FN) sentinel lymph node (SLN) cases, their correlation with a series of clinico-pathologic parameters and their impact on adjuvant treatment indications and on clinical axillary relapse in the setting of a multicentric clinical trial comparing SLN biopsy with axillary lymph node dissection (ALND).

Methods

A series of 697 patients with primary breast cancer ≤ 3 cm were randomized to SLN biopsy associated with ALND (ALND arm) or to SLN biopsy followed by ALND only if the SLN was metastatic (SLN arm). The FN SLN rate was assessed in the ALND arm. A series of 11 clinico-pathological parameters were tested for a possible association with FN results. The indications for adjuvant treatments were evaluated by considering both the FN nodal stages, as indicated by the SLN, and the true positive axillary status, as indicated by completion ALND. The occurrence of clinically evident axillary recurrences was evaluated in the two arms.

Results

The FN rate was 16.7%. Of the clinico-pathologic parameters tested, only a tumour size ≤ 2 cm and the presence of a single metastatic axillary node was significantly associated with a risk of FN (p = 0.033 and p = 0.018, respectively). The FN SLN would have led to different adjuvant therapy indications in 12/18 cases. At 56 months, no clinically evident axillary nodal recurrences were present in the ALND arm patients, whereas one case of axillary recurrence was detected in the SLN arm patients.

Conclusions

FN SLN biopsy is not uncommon, especially in the presence of a small primary tumour with a single nodal metastasis. An FN finding can lead to less than optimal adjuvant treatment. However, the clinical impact of FN in terms of axillary recurrence at 56 months was minimal.