CAJ | 학술논문

目的探讨乳腺癌患者术后上肢淋巴显像的影像学特征和诊断方法,评估其对乳腺癌相关性淋巴水肿的诊断价值.方法 79例乳腺癌术后患者(上肢数158),于患者双侧第1指间皮下注射99Tcm-右旋糖酐,分别于10 min和1,3,6 h行淋巴显像.以患侧上肢为研究组(上肢数79),健侧为对照组(上肢数79).计算淋巴显像对诊断淋巴水肿的灵敏度、特异性和准确性.结果 2组上肢淋巴显像在淋巴结显示数量、淋巴管完整性和显像剂回流方式等方面存在明显差异:对照组96.2%(76/79)上肢淋巴管显示完整,而研究组仅5.1%(4/79)显示完整.淋巴结显影差异较大,对照组腋窝和锁骨上淋巴结显示数量≥2枚者分别为87.3%(69/79)和74.7%(59/79),研究组无腋窝淋巴结显示≥2枚者(0/79),锁骨上淋巴结仅5.1%(4/79)显示≥2枚.研究组显像剂回流方式可见4种类型:正常型(2.5%,2/79)、淋巴管扩张型(55.7%,44/79)、弥漫型(36.7%,29/79)和无回流型(5.1%,4/79).分别以"显像剂回流异常"和"淋巴管不完整"作为诊断乳腺癌相关性淋巴水肿的标准,则诊断灵敏度、特异性分别为94.8%(73/77),100.0%(81/81)和97.5%(77/79)、96.2%(76/79).两者结合,灵敏度和特异性均可提高到100%(77/77和81/81).结论核素淋巴显像因其准确、有效和无创的特点,是评估乳腺癌患者上肢淋巴管、淋巴结和淋巴引流情况的首选方法.
목적 탐토유선암환자술후상지림파현상적영상학특정화진단방법,평고기대유선암상관성림파수종적진단개치.방법 79례유선암술후환자(상지수158),우환자쌍측제1지간피하주사99Tcm-우선당항,분별우10 min화1,3,6 h행림파현상.이환측상지위연구조(상지수79),건측위대조조(상지수79).계산림파현상대진단림파수종적령민도、특이성화준학성.결과 2조상지림파현상재림파결현시수량、림파관완정성화현상제회류방식등방면존재명현차이:대조조96.2%(76/79)상지림파관현시완정,이연구조부5.1%(4/79)현시완정.림파결현영차이교대,대조조액와화쇄골상림파결현시수량≥2매자분별위87.3%(69/79)화74.7%(59/79),연구조무액와림파결현시≥2매자(0/79),쇄골상림파결부5.1%(4/79)현시≥2매.연구조현상제회류방식가견4충류형:정상형(2.5%,2/79)、림파관확장형(55.7%,44/79)、미만형(36.7%,29/79)화무회류형(5.1%,4/79).분별이"현상제회류이상"화"림파관불완정"작위진단유선암상관성림파수종적표준,칙진단령민도、특이성분별위94.8%(73/77),100.0%(81/81)화97.5%(77/79)、96.2%(76/79).량자결합,령민도화특이성균가제고도100%(77/77화81/81).결론 핵소림파현상인기준학、유효화무창적특점,시평고유선암환자상지림파관、림파결화림파인류정황적수선방법.
Objective To investigate the imaging characteristics of lymphoscintigraphy in postoperative breast cancer patients and evaluate its diagnostic value in breast cancer-related lymphedema (BCRL).Methods Seventy-nine breast cancer patients who underwent mastectomy and axillary lymph node dissection were studied. Patients ( n = 158 ) were divided into the study ( affected arms, n = 79 ) and control groups ( contralateral arms, n = 79). After subcutaneous injection of 99Tcm-dextran via the first interphalangeal space, lymphoscintigraphy was performed at 10 min, 1,3, 6 h respectively. Sensitivity and specificity of lymphoscintigraphy for detection of BCRL were calculated. Results There were significant differences in the amount of visualized lymph nodes, lymphatic integrity and backflow pattern between the two groups.Lymphatic drainage was preserved in 96.2% (76/79) of the contralateral arms and only 5.1% (4/79) of affected arms. 87.3% (69/79) and 74.7% (59/79) of control arms had ≥2 lymph nodes in axilla and supraclavicular regions, respectively; while none ( 0/79 ) and 5.1% (4/79) of the affected arms had ≥ 2lymph nodes in both regions, respectively. Four backflow patterns of radiotracer in subcutis were observed in the affected arms: normal (2.5% , 2/79), dilatated (55.7%, 44/79), diffused (36.7%, 29/79) and without backflow (5.1%, 4/79 ). The sensitivity and specificity of "lymphatic integrity" and "backflow pattern" on lymphoscintigraphy for detecting BCRL were 97.5% (77/79) and 96.2% (76/79), 94.8%(73/77) and 100.0% (81/81), respectively. Conclusion Lymphoscintigraphy is a noninvasive, accurate and effective imaging modality for the evaluation of BCRL.