磁共振弥散加权成像及ADC值对鼻咽癌颅底放疗疗效的评价价值

目的:探讨磁共振弥散加权成像(DWI)及表观扩散系数(ADC)值在鼻咽癌颅底放疗中的临床价值。方法:收集我院于2013年6月~2014年6月复查的40例鼻咽癌患者,分别于放疗前及放疗结束12个月以后对所有患者行常规核磁共振成像(MRI)及DWI检查,测量放疗前、后ADC值,根据影像学检查以及临床诊断结果分为复发组(n=5)及未复发组(n=35)。结果:复发组放疗前ADC值为(0.797±0.031)×10~(-3)mm~2/s,与未复发组放疗前ADC值(0.805±0.028)×10~(-3)mm~2/s比较,差异无统计学意义(P0.05)。复发组放疗结束12个月以后ADC值为(1.097±0.091)×10~(-3)mm~2/s,与未复发组放疗结束12个月以后ADC值(1.705±0.128)×10~(-3)mm~2/s比较,差异有统计学意义(P0.05)。结论:DWI作为一种新兴的磁共振成像技术,对于鼻咽癌颅底放疗疗效的评价具有重要价值,通过DWI对ADC值的测量,可有效的预测患者预后是否良好。     

MR弥散加权成像对鉴别诊断良恶性椎体压缩性骨折的临床价值研究

目的：探讨MR弥散加权成像（DWI）鉴别诊断良恶性椎体压缩性骨折的临床价值。方法：对57例经临床或病理证实的椎体良恶性压缩性骨折患者行矢状位T1M、T2WI、T2WI／FS及DWI扫描,研究其在常规序列和DWI序列上的表现,将常规MR序列和DWI序列检出率进行比较,测量正常椎体及病变椎体的表观弥散系数（ADC）值,并进行统计学分析。结果：（1）MR常规序列和DWI序列（b=500s／mm2）表现：良性椎体压缩性骨折呈长T1长或等T2改变,T2WI／FS呈高信号,DWI可以呈高信号、等信号及低信号;恶性椎体压缩性骨折呈长T1长T2信号,大部分病灶T2WUFS及DWI呈高信号,少数变现为低信号;（2）MR常规序列和DWI序列（b=500s／mm2）病灶检出率的比较：T1WI、T2WI／FS及DWI序列病灶检出率均高于T2WI序列,其间的差别有显著性意义（P〈0．01）,T1WI、T2WI／FS及DWI序列病灶检出率之间无显著性差异（P〉0．01）;（3）ADC值比较：在DWI（b=500s／mm2）上,良性组ADC值为（2．03±0．83）×10^3mm^2/s,恶性组ADC值为（1．37±0．75）×10^-3mm^2/s,正常组ADC值为（0．36±0．21）×10^-3mm^2／s,成像条件相同时,良性组高于恶性组,两组间有明显的统计学意义（P〈0．05）。结论：DWI可较好的反映椎体的弥散特征,ADC值作为量化指标可对良恶性椎体压缩性骨折进行可靠鉴别。     

MR 弥散加权成像对鉴别诊断良恶性椎体压缩性骨折的临床价值研究

目的：探讨MR弥散加权成像(DWI)鉴别诊断良恶性椎体压缩性骨折的临床价值。方法：对57 例经临床或病理证实的椎体 良恶性压缩性骨折患者行矢状位T1WI、T2WI、T2WI/FS 及DWI扫描,研究其在常规序列和DWI序列上的表现,将常规MR 序列 和DWI序列检出率进行比较,测量正常椎体及病变椎体的表观弥散系数(ADC)值,并进行统计学分析。结果：(1)MR 常规序列和 DWI序列(b=500s/mm2)表现：良性椎体压缩性骨折呈长T1 长或等T2 改变,T2WI/FS 呈高信号,DWI 可以呈高信号、等信号及低 信号;恶性椎体压缩性骨折呈长T1 长T2 信号,大部分病灶T2WI/FS 及DWI呈高信号,少数变现为低信号;(2)MR 常规序列和 DWI 序列(b=500s/mm2)病灶检出率的比较：T1WI、T2WI/FS 及DWI序列病灶检出率均高于T2WI 序列,其间的差别有显著性意 义(P<0.01),T1WI、T2WI/FS 及DWI序列病灶检出率之间无显著性差异(P>0.01);(3)ADC 值比较：在DWI(b=500 s/mm2)上,良性组 ADC 值为(2.03± 0.83)× 10-3mm2/s,恶性组ADC 值为(1.37 ± 0.75)× 10-3mm2/s,正常组ADC值为(0.36± 0.21)× 10-3mm2/s,成像条 件相同时,良性组高于恶性组,两组间有明显的统计学意义(P<0.05)。结论：DWI可较好的反映椎体的弥散特征,ADC值作为量化 指标可对良恶性椎体压缩性骨折进行可靠鉴别。     

早期糖尿病肾病大鼠模型磁共振弥散加权成像的初步研究

目的:探讨早期糖尿病肾病(Diabetic nephropathy,DN)模型大鼠磁共振弥散加权成像(Diffusion Weight Imaging,DWI)肾实质ADC值变化规律。方法:将20只清洁级雄性SD大鼠随机分成两组,糖尿病肾病组(DN组)12只,正常对照组(NC组)8只;DN组给予60 mg/kg链尿佐菌素腹腔注射诱导糖尿病肾病模型,NC组按照相同方法、相同剂量柠檬酸缓冲液腹腔注射;并对最终糖尿病模型造模成功并且存活的8只DN大鼠、8只NC大鼠进行MRI扫描,包括常规轴位T1WI、T2WI扫描及DWI扫描;扫描结束后收集血液送血肌酐及双肾组织进行病理检查。并测量每只大鼠双肾皮、髓质的ADC值。结果:造模后,DN组大鼠血糖明显升高、尿量明显增加、体重明显减低,DN组大鼠肾脏出现不同程度病理损伤,符合早期DN病理改变。DN组大鼠肾脏皮、髓质ADC值分别为1.522±0.913×10^-3 mm^2/s、1.268±0.388×10^-3 mm^2/s,较NC组肾脏皮、髓质ADC值1.276±0.341×10^-3 mm^2/s、1.011±0.217×10^-3 mm^2/s增高,两组比较有统计学意义(P<0.05)。结论:DWI成像ADC值可能反映早期糖尿病肾病肾脏功能的变化。     

MRI多b值DWI序列在孤立性肺结节良恶性鉴别诊断中的价值

目的:评价MRI多b值DWI序列在孤立性肺结节(SPN)良、恶性鉴别诊断中的价值。方法:选取2015年9月-2016年6月于我院行CT检查发现并未经治疗的78例SPN患者,在穿刺活检或手术前行MRI胸部检查,根据结节直径分为三组:D1≤10mm、10 mmD2≤20 mm、20 mmD3≤30 mm,DWI扫描b值(0 s/mm~2、400 s/mm~2、600 s/mm~2、800 s/mm~2)。分别测量不同b值下结节DWI图的信号评分和拟合ADC图的表观扩散系数(ADCtot值),参照病理结果进行对比分析。结果:在b值为400 s/mm~2时,良恶性结节DWI信号差异在D1组间无统计学意义(P0.05);当b值为600 s/mm~2时,良恶性结节DWI信号差异在(D1、D2、D3)组间均具有统计学意义(P0.05),且结节信号强度越高其恶性可能性越大;在b值为800 s/mm~2时,良恶性结节DWI信号差异在D3组间无统计学意义(P0.05);在良恶性结节ADCtot值对比分析中发现,不同良性结节的ADCtot值均较恶性结节偏高,差异具有统计学意义(P0.05);以3为信号阈值,1.50×10~(-3) mm~2/s为ADCtot阈值,对SPN的特异性、准确性、阳性预测值、阴性预测值均较信号强度评分升高(P0.05)。结论:MRI弥散加权成像评价SPN过程中,多b值拟合ADCtot值对病变良恶性鉴别能力较好。在b值为600 s/mm~2时,其信号强度差异对SPN的良恶性信号评价效能最佳,多b值DWI序列对SPN良恶性的鉴别诊断具有重要价值。     

前列腺癌MRI灌注指标与ADC值的相关性研究

目的:探讨前列腺癌磁共振灌注加权成像和弥散加权成像参数的相关性,从影像学角度上间接反映前列腺癌微循环灌注水平与癌组织增殖的内在关系.方法:对前列腺癌病例49例,均使用GE Echo-speed1.5T超导成像仪行PWI和DWI.在工作站应用functool软件.获得PWI信号-时间曲线(signal intensity-time curve,SI-TC)图和各灌注参数相对值,并计算ADC值.结果:前列腺癌、良性前列腺增生、正常前列腺外周组织的相对负增强积分(rNEI)依次降低且具有统计学差异(P<0.05)前列腺癌的rNEI与Gleason分级、TNM、PSA分期均呈正相关关系(P<0.05)前列腺癌、良性前列腺增生和正常前列腺组织的ADC值依次升高(P<0.05).前列腺癌的rNEI与ADC呈负相关关系(P<0.05).结论:联合应用PWI和DWI可以从影像学的角度上间接提示血流供应与前列腺癌组织增殖的关系.     

磁共振全身扩散加权成像在不同类型淋巴瘤中的应用价值研究

目的:探讨磁共振全身扩散加权成像(WB-DWI)在不同病理类型淋巴瘤的筛查、诊断及治疗中的应用价值。方法:选择2015年1月~2017年6月经我院病理证实的淋巴瘤患者60例作为淋巴瘤组,另选择同期健康志愿者43例作为对照组,所有对象均进行磁共振WB-DWI检查(淋巴瘤组于治疗前和治疗后检查),测量其淋巴结表观扩散系数(ADC)值,比较淋巴瘤组与对照组、淋巴瘤组不同部位、不同病理类型及治疗前后不同疗效淋巴瘤患者的淋巴结ADC值差异。结果:淋巴瘤组平均ADC值为(755.37±48.42)×10-6 mm~2/s,低于对照组的(1185.92±66.53)×10-6 mm~2/s,差异有统计学意义(P0.05);不同部位、不同病理类型(包括不同细胞来源)淋巴瘤患者的ADC值比较,差异无统计学意义(P0.05);不同疗效淋巴瘤患者的ADC值治疗前与治疗后比较,差异有统计学意义(P0.05);治疗前、治疗后不同疗效淋巴瘤患者的ADC值比较,差异有统计学意义(P0.05)。结论:淋巴瘤患者WB-DWI的ADC值较健康者显著降低,而且不同疗效的淋巴瘤患者具有不同的ADC值,因此,WB-DWI检查可作为淋巴瘤的筛查、诊断及疗效评估的方法。     

磁共振弥散加权成像预测宫颈癌早期放化疗疗效及预后

目的:探讨磁共振弥散加权成像(DWI)在预测宫颈癌患者早期放化疗效果及预后的应用价值。方法:选择2011年2月~2014年2月在我院住院并接受同期放化疗的宫颈癌患者共74例,于放化疗前、放化疗中、放化疗结束时进行磁共振(MR)扫描及DWI检查。记录不同时间段的肿瘤体积和宫颈癌表观弥散系数(ADC)变化,依据实体瘤的疗效评价标准(RECIST)标准比较放化疗前后不同疗效组ADC值及其变化率。对患者进行18个月的随访,以病理切片检查结果为金标准,分析DWI对宫颈癌复发诊断的灵敏度和特异度。结果:放化疗前、中、结束时患者的肿瘤体积和ADC值差异具有统计学意义(P0.05);与放化疗前相比,不同疗效组放化疗后的ADC值均明显升高(P0.05),且放化疗后各组ADC值和ADC变化率之间差异均具有统计学意义(P0.05);DWI对宫颈癌复发诊断的灵敏度和特异度分别为95.83%和95.45%。结论:DWI可以预测宫颈癌早期放化疗临床疗效,并对患者预后评估具有较高的灵敏度和特异度,值得在临床上广泛推广。     

MR扩散加权成像和CT及MR灌注成像对不同程度肝硬化患者的诊断价值

目的:研究MR扩散加权成像(DWI)和CT及MR灌注成像对不同程度肝硬化患者的诊断价值。方法:选择从2015年8月到2017年2月在我院治疗的肝硬化患者60例作为研究对象,根据Child-Pugh分级进行分组,其中A级32例为轻度肝硬化(记为A组),B级16例、C级12例为中重度肝硬化(记为B组),另选同期在我院进行体检的健康志愿者30例记为C组,对三组受试者分别进行DWI检查、CT及MR灌注成像,对比各组ADC值、肝脏动门脉灌注比率[SSr(ct)及SSr(mr)],采用Spearman相关性分析各指标之间的相关性。结果:三组ADC值整体比较无统计学差异(P0.05),A、B两组的ADC值较C组降低,但差异无统计学意义(P0.05)。A、B两组的ADC值比较无统计学差异(P0.05)。三组SSr(ct)、SSr(mr)整体比较,差异有统计学意义(P0.05),B组的SSr(ct)及SSr(mr)较A、C两组明显升高,差异均有统计学意义(均P0.05)。A、C两组的SSr(ct)及SSr(mr)比较无统计学差异(P0.05)。Spearman相关性分析显示,不同程度肝硬化患者的SSr(ct)与SSr(mr)呈正相关(r=0.687,P=0.000)。结论:CT以及MR灌注成像均可较好地反映出肝硬化的病变程度,且二者较DWI成像的诊断效果更佳,值得临床推广。     

磁共振扩散加权成像对宫颈癌诊断价值及其与临床病理特征的关系研究

目的:研究磁共振扩散加权成像(DWI)对宫颈癌的诊断价值及其与临床病理特征的关系。方法:将2016年5月至2018年5月间于本院接受诊治的90例宫颈癌患者作为研究组,其中鳞癌69例,腺癌21例。另选择同期因其他原因来本院行宫颈检查的90例非宫颈癌患者作为对照组,两组患者均接受常规磁共振成像(MRI)平扫及DWI检查。观察两组MRI影像学特征,分别比较研究组和对照组、不同病理分型以及不同临床病理特征宫颈癌患者表观弥散系数(ADC)值,采用受试者工作特征(ROC)曲线评价DWI检查对宫颈癌的诊断价值,并分析宫颈癌患者ADC值与临床病理特征的关系。结果:研究组和对照组的MRI影像学图像全部符合诊断和测量要求,无显著的伪影、变形;研究组患者的病变位在宫颈,其信号特征T1加权像(T1WI)显示为等信号,而T2加权像(T2WI)显示为稍高/高信号,经DWI检查显示为高信号肿块,且边界清晰。研究组患者DWI检查的ADC值低于对照组(P0.05);鳞癌患者DWI检查的ADC值也明显低于腺癌患者(P0.05)。ROC曲线结果显示,DWI检查鉴别诊断宫颈癌和非宫颈癌、鳞癌和腺癌的AUC分别为0.912、0.827。无淋巴结转移、临床病理分期为Ⅰ-Ⅱ期、中/高分化以及肿瘤细胞间质占比70%的宫颈癌患者ADC值分别高于有淋巴结转移、临床病理分期为Ⅲ-Ⅵ期、低分化以及肿瘤细胞间质占比≥70%的宫颈癌患者(均P0.05)。结论:DWI对宫颈癌诊断价值高,且DWI成像参数ADC值和宫颈癌的部分临床病理特征关系密切,能从一定程度上辅助医师了解宫颈癌病理分型、病理分期、分化程度及有无淋巴结转移。     

Density of intranodal lymphatics and VEGF-C expression in B-cell lymphoma and reactive lymph nodes

Lymphatic vasculature in solid tumors may serve as the pathway for metastatic spread of the cancer to the regional lymph nodes and to distant organs. Controversy still exists whether tumors metastasize through existing lymphatics or through newly formed vessels (lymphangiogenesis). The role of lymphangiogenesis in lymphoma spread and proliferation is not clearly established. VEGF-C is the most potent inducer of lymphangiogenesis. LYVE-1 was shown to be a specific marker for lymphatic vessels in normal and tumor tissue. The aim of the present study was the evaluation of lymph node LYVE-1-positive lymphatic sinus density (LSD) and VEGF-C expression in patients with non-Hodgkin's lymphoma (nHL) and in reactive lymph nodes. Sixty paraffin-embedded lymph nodes from newly diagnosed patients with B-cell nHL were evaluated. Twelve lymph node biopsy specimens from adult patients with reactive lymphonodulitis were used as controls. Sections of lymph nodes were stained immunohistochemically for LYVE-1 and VEGF-C. VEGF-C expression in lymph nodes of nHL patients was low and not significantly different from that in the control (p = 0.6). Moreover, VEGF-C expression did not differ significantly between aggressive and indolent lymphomas (p = 0.53). Similarly we did not find differences in LSD in aggressive nHL and in indolent nHL (p=0.49). The mean LSD in reactive lymph nodes was higher than in nHL (p = 0.03). Only in 2 out of 12 reactive lymph nodes LYVE-1-positive vessels were absent. In all groups we demonstrated a strong positive correlation between VEGF-C and LYVE-1-expression (p = 0.0001). Higher LSD in reactive lymph nodes as compared to those of nHL patients suggests that lymphoma proliferation leads to the destruction of the existing lymphatics rather than to lymphangiogenesis within lymph nodes. NHL are not associated with increased expression of VEGF-C nor increased LYVE-1-positive lymphatic sinuses density within lymph nodes.     

超声弹性成像技术对腋窝淋巴结性质的诊断价值

目的:研究超声成像技术对腋窝淋巴结性质的诊断价值。方法:从2013年5月至2014年2月,选择我院50例乳腺癌患者,对所有患者进行弹性成像技术检测出74个腋窝淋巴结。对所有腋窝淋巴结使用四分法进行评分,将其与手术病理结果进行比较。结果:74个腋窝淋巴结中,反应性淋巴结有42个,纵径为(0.9-2.4)cm,平均纵径为(1.31±0.33)cm;乳腺癌腋窝淋巴结转移个数为25个,纵径为(1.2±3.8)cm,平均纵径为(2.04±0.72)cm。良性淋巴结弹性评分大多为1分(54.55%)以及2分(27.27%),恶性淋巴结评分多为3分(63.33%)以及4分(20.00%)。恶性淋巴结评分为(3.12±0.61)分,良性淋巴结评分为(1.68±0.74)分,结果显示,两组淋巴结弹性评分具有较大差异(即P<0.05),具有可比性。结论:综上所述,超声弹性成像技术操作较为简便,效果较为直观,评分法能够提供组织的硬度信息,在临床工作中,与常规超声联合应用有利于提高评价腋窝淋巴结良恶性性质的准确度。值得临床推荐使用。     

Proinflammatory chemokine gene expression influences survival of patients with non-Hodgkin's lymphoma

The migration, survival and proliferation of cells is the basis for all physiologic and pathologic processes in the human body. All these reactions are regulated by a complex chemokine network that guides lymphocytes homing, chemotaxis, adhesion and interplay between immunologic system response cells. Chemokines are also responsible for metastatic dissemination of cancers, including Hodgkin's and non-Hodgkin's lymphomas. The purpose of this study was to determine chemokine gene expression (CXCL8, CXCL10, CCL2, CCL3, CCL4 and CCL5) in lymphoma lymph nodes compared to their expression in reactive lymph nodes. We also analyzed the influence of chemokine gene expression on the survival of lymphoma patients. Chemokine gene expression was evaluated in 37 lymphoma lymph nodes and in 25 samples of reactive lymph nodes. Gene expression of chemokines CXCL8, CXCL10, CCL2, CCL3, CCL4 and CCL5 was measured using the PCR method. Statistical analysis was performed using CSS Statistica for Windows (version 7.0) software. Probability values 〈 〈 0.05 were considered statistically significant and those between 0.05 and 0.1 as indicative of a trend. We found lower CXCL8 and CXCL10 gene expression in lymphoma lymph nodes compared to reactive lymph nodes. In the cases of CCL2 and CCL3, expression in lymphomas was higher than in reactive lymph nodes. Patients with high expression of CCL2 and CXCL10 had shorter survival.     

The diagnostic value of thyroglobulin concentration in fine-needle aspiration of the cervical lymph nodes in patients with differentiated thyroid cancer

INTRODUCTION: Recurrent differentiated thyroid cancer generally occurs first in the neck. Ultrasound is sensitive in detecting enlarged cervical lymph nodes but is not specific enough. Ultrasound-guided fine-needle biopsy increases the specificity but still may fail to detect a recurrence of the disease in the cystic metastatic lymph nodes. The aim of the study was to estimate the value of Tg concentration in the needle washout after fine-needle aspiration of suspicious lymph nodes. MATERIAL AND METHODS: The 105 patients studied had presented one or more enlarged suspicious cervical lymph nodes. All had undergone total thyroidectomy and (131)I ablative therapy. Serum thyroglobulin (Tg) concentration was within the 0.15-711.5 ng/ml range (mean 22.24 ng/ml) and Tg recovery range 94-100%. The positive Tg washout concentration cut-off value was established as equal to the mean plus two standard deviations of the Tg washout concentration of patients with negative cytology. RESULTS: Lymph node involvement was diagnosed by cytology in 15 patients and in 28 lymph nodes. Positive Tg washout concentration was found in 22 patients and in 48 lymph nodes. All the lymph nodes which turned out to have positive cytology had a positive Tg washout concentration. All lymph nodes with positive cytology were positive in pathology. Seven patients and 20 lymph nodes with negative cytology were positive in the Tg washout concentration test. All but one patients and all but two lymph nodes with a positive Tg washout concentration had positive pathology. CONCLUSIONS: 1. Ultrasound-guided fine-needle biopsy is not sensitive enough to detect all metastatic lymph nodes. 2. The Tg washout concentration test is 100% sensitive in the detection of metastatic lymph nodes. 3. Cytology in ultrasound- guided fine-needle biopsy is 100% specific. 4. The Tg washout concentration test carries a risk of false-positive results. 5. Both methods should be used for early detection of metastatic lymph nodes in patients with differentiated thyroid cancer.     

Imaging Lymphatic System in Breast Cancer Patients with Magnetic Resonance Lymphangiography

Objective

To investigate the feasibility of gadolinium (Gd) contrast-enhanced magnetic resonance lymphangiography (MRL) in breast cancer patients within a typical clinical setting, and to establish a Gd-MRL protocol and identify potential MRL biomarkers for differentiating metastatic from non-metastatic lymph nodes.

Materials and Methods

32 patients with unilateral breast cancer were enrolled and divided into 4 groups of 8 patients. Groups I, II, and III received 1.0, 0.5, and 0.3 ml of intradermal contrast; group IV received two 0.5 ml doses of intradermal contrast. MRL images were acquired on a 3.0 T system and evaluated independently by two radiologists for the number and size of enhancing lymph nodes, lymph node contrast uptake kinetics, lymph vessel size, and contrast enhancement patterns within lymph nodes.

Results

Group III patients had a statistically significant decrease in the total number of enhancing axillary lymph nodes and lymphatic vessels compared to all other groups. While group IV patients had a statistically significant faster time to reach the maximum peak enhancement over group I and II (by 3 minutes), there was no other statistically significant difference between imaging results between groups I, II, and IV. 27 out of 128 lymphatic vessels (21%) showed dilatation, and all patients with dilated lymphatic vessels were pathologically proven to have metastases. Using the pattern of enhancement defects as the sole criterion for identifying metastatic lymph nodes during Gd-MRL interpretation, and using histopathology as the gold standard, the sensitivity and specificity were estimated to be 86% and 95%, respectively.

Conclusion

Gd-MRL can adequately depict the lymphatic system, can define sentinel lymph nodes, and has the potential to differentiate between metastatic and non-metastatic lymph nodes in breast cancer patients.     

Dynamics of aberrant methylation of functional groups of genes in progression of breast cancer

For the first time, the epigenetic status of breast benign proliferative processes, malignant breast tumors, and metastases to regional lymph nodes has been studied using the GoldenGate Cancer Panel I DNA methylation microarray (Illumina, United States). The functional groups of differentially methylated genes were identified in each set of samples. The aberrant methylation of genes that regulate cell proliferation and mobility was found in the samples of benign proliferative breast processes. The aberrant methylation of genes responsible for cell differentiation and proliferation, as well as protein phosphorylation and cell mobility, was observed in the samples of malignant breast tumors. The differential methylation of the genes that regulate cell adhesion, the formation of anatomical structures, angiogenesis, immune response, signal transduction, and protein phosphorylation were found in samples with metastases to regional lymph nodes compared to the unaltered breast epithelium. It was found that tissues that range from benign proliferative processes and metastases to regional lymph nodes were generally characterized by a relatively lower level of epigenetic variability compared to the tissues of the primary tumor.     

高频彩色多普勒超声对乳腺癌腋窝淋巴结性质的鉴别价值

目的:研究高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结的鉴别价值。方法:选择2015年2月~2016年6月在我院进行诊治的乳腺癌患者150例,应用高频二维超声结合彩色多普勒血流显像技术,观察腋窝肿大淋巴结的声像图及血流情况。结果:经二维超声发现,乳腺癌腋窝良性淋巴结的皮质多向心增厚(68.93%)、长短径比L/S多2.0(70.58%)、多不融合(93.14%)、多无钙化斑(97.06%);腋窝转移性淋巴结的皮质多偏心增厚(68.48%)、长短径比L/S多2.0(69.57%)、多融合(68.48%)、多有钙化斑(77.17%);两者相比有明显差异(P0.05);经彩色多普勒血流显像技术发现,乳腺癌腋窝良性淋巴结的血流信号分布多呈门型(63.17%),血流丰富程度多为Ⅱ级(54.35%);腋窝转移性淋巴结的血流信号分布多呈周边型(68.93%),血流丰富程度多为Ⅲ级(72.83%);两者相比有明显差异(P0.05)。结论:乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结在内部回声、形态、血流分布特点等方面有显著的差异,高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结具有较高的鉴别价值。     

Pathology of supraclavicular lymphadenopathy in Chandigarh, north India: an audit of 200 cases diagnosed by needle aspiration

OBJECTIVE: Fine needle aspiration cytology (FNAC) of lymph nodes can be used routinely as a first-line diagnostic test. The majority of studies reveal a malignant cause for palpable supraclavicular lymph nodes. The present audit further emphasizes the use of FNAC as a first-line investigation for the evaluation of enlarged supraclavicular lymph nodes. METHODS: A total of 200 cases of palpable supraclavicular lymph node(s) were included in the present study. RESULTS: Left supraclavicular lymph nodes were found to be more commonly involved (59.5% cases). Sixty-four per cent cases showed metastatic deposits and 13.5% cases were diagnosed as tuberculosis. Ten per cent cases showed reactive lymphoid hyperplasia; 0.5% (one) case showed only necrosis and on autopsy, a microscopic focus of choriocarcinoma was found in the testis. In 7.5% cases, diagnostic material could not be aspirated despite repeated attempts. Common metastatic tumours were from lung (22% cases), breast (16.4% cases), cervix (11% cases) and oesophagus (8.6% cases). In 13.3% cases the primary site was unknown and the diagnosis of malignancy first came from FNAC. CONCLUSION: The present study further highlights the importance of FNAC as a first-line diagnostic modality in the evaluation of supraclavicular lymphadenopathy. A full history, radiological findings and immunochemistry in difficult cases can help to arrive at a definitive diagnosis.     

Sentinel lymph node imaging using quantum dots in mouse tumor models

We demonstrate that quantum dots injected into two model tumors rapidly migrate to sentinel lymph nodes. PEG-coated quantum dots having terminal carboxyl, amino, or methoxyl groups all migrated from the tumor to surrounding lymph nodes similarly. Passage from the tumor through lymphatics to adjacent nodes could be visualized dynamically through the skin; at least two nodes could usually be defined. Imaging during necropsy confirmed confinement of the quantum dots to the lymphatic system and demonstrated easy tagging of sentinel lymph nodes for pathology. Examination of the sentinel nodes identified by quantum dot localization showed that at least some contained metastatic tumor foci.