摘要
目的分析乳腺癌同侧腋窝淋巴结阳性的临床特点、影像学特征及漏诊原因,并总结防范漏诊措施。方法回顾性分析2021年9-12月收治的曾漏诊的乳腺癌同侧腋窝淋巴结阳性15例的临床资料。结果本组均有乳房肿块,1例腋窝有刺痛,3例腋窝查体有淋巴结增大、质硬。15例均行腋窝常规超声检查,3例发现腋窝淋巴结稍增大伴或不伴皮质增厚、脂肪门消失;2例发现腋窝淋巴结皮质增厚伴或不伴脂肪门消失。乳腺X线、乳腺增强CT或乳腺增强MRI 7例有异常发现。入院后均根据腋窝超声检查及腋窝淋巴结针吸细胞学检查结果诊断同侧腋窝淋巴结阴性。漏诊时间3~7 d。15例均行乳腺癌根治性手术,根据术后组织病理学及免疫组织化学检查结果确诊同侧腋窝淋巴结阳性,给予相应治疗均获得较好无病生存期及总生存期。随访6个月,无复发及转移。结论同侧腋窝淋巴结阳性是否确诊对乳腺癌患者制订治疗决策起至关重要的作用。临床医生应结合患者临床特点、影像学特征及针吸细胞学检查结果综合分析对其进行判断,以减少或避免漏诊。
Objective To analyze the clinical characteristics,imaging features and causes of missed diagnosis of positive ipsilateral axillary lymph node in breast cancer,and to summarize the measures to prevent missed diagnosis.Methods Clinical data of 15 patients of breast cancer with positive ipsilateral axillary lymph node who had been missed between September 2021 and December 2021 were retrospectively analyzed.Results In this group,all patients had breast masses,of whom 1 patient had axillary tingling,and 3 patients had enlarged and hard axillary lymph node.All 15 patients underwent conventional ultrasound examination of the axilla,and 3 patients showed slightly enlarged axillary lymph nodes with or without cortical thickening and fatty hilum disappearance.Axillary lymph node cortex thickening with or without fatty hilum disappearance was found in 2 patients.Breast X-ray,chest enhanced CT or breast enhanced MRI detected abnormalities in 7 patients.According to axillary ultrasonography and axillary lymph node needle aspiration cytology,the 7 patients were diagnosed with negative ipsilateral axillary lymph nodes.The duration of missed diagnosis was 3-7 d.All 15 patients underwent radical mastectomy for breast cancer.According to postoperative histopathology and immunohistochemistry,the ipsilateral axillary lymph nodes were confirmed to be positive.After corresponding treatment,good disease-free survival and overall survival were obtained.All patients were followed up for six months without recurrence and metastasis.Conclusion The diagnosis of positive ipsilateral axillary lymph node plays an important role in making treatment decisions for breast cancer patients.Clinicians should make a comprehensive analysis and evaluation based on the clinical characteristics,imaging features and needle aspiration cytology results of patients,to reduce or avoid missed diagnosis.
作者
程代明
吴斌
CHENG Dai-ming;WU Bin(Department of Breast Surgery,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)
出处
《临床误诊误治》
CAS
2022年第10期22-25,共4页
Clinical Misdiagnosis & Mistherapy
关键词
乳腺肿瘤
腋窝淋巴结
影像学
细胞学
漏诊
Breast neoplasms
Axillary lymph nodes
Imaging
Cytology
Missed diagnosis
